Chest Disease Department, Ankara University Medical Faculty, Ankara, Turkey.
Cardiology Department, Ankara University Medical Faculty, Ankara, Turkey.
Malawi Med J. 2020 Sep;32(3):176-179. doi: 10.4314/mmj.v32i3.11.
Tuberculous pleuritis can rarely cause haemorrhagic pleural effusion. Dabigatran etexilate can have an additive effect on increasing the risk of haemorrhage. Aspirin cannot cause major haemorrhage, but in the elderly it can cause gastrointestinal bleeding via ulceration of the gastrointestinal mucosa. We report here the case of a 77-year-old male who presented to the hospital with a 2-month history of progressive dyspnoea. He had been taking dabigatran etexilate (220 mg) and high-dose acetylsalicylic acid (aspirin; 300 mg) daily for chronic atrial fibrillation. A chest X-ray revealed a moderately sized right pleural effusion confirmed by a computed tomography scan, which also showed bronchiectasis of both lungs. Dabigatran was discontinued and aspirin was decreased to the minimal therapeutic dose of 100 mg before thoracentesis was performed. Lymphocyte-predominant (50%) haemorrhagic fluid of 500 ml was drained, positive for acid-fast bacilli smear and polymerase chain reaction of Mycobacterium tuberculosis. A chest tube was placed and an additional 1250 ml of haemorrhagic exudate drained out. We treated the patient with a routine regimen of antituberculous medication and the infection resolved without complications other than the bronchiectasis present before treatment. We think that the combination of dabigatran etexilate and high doses of aspirin increased the risk of pleural haemorrhage in this patient with tuberculous pleuritis.
结核性胸膜炎很少引起血性胸腔积液。达比加群酯可增加出血风险的附加作用。阿司匹林不会引起大出血，但在老年人中，它会通过胃黏膜溃疡引起胃肠道出血。我们在此报告一例 77 岁男性病例，该患者因进行性呼吸困难就诊 2 个月。他一直每天服用达比加群酯（220mg）和大剂量乙酰水杨酸（阿司匹林；300mg）治疗慢性心房颤动。胸部 X 线片显示中等大小的右侧胸腔积液，胸部 CT 扫描证实了这一点，还显示双肺支气管扩张。在进行胸腔穿刺术之前，停用了达比加群酯，并将阿司匹林减少到最小治疗剂量 100mg。引流了 500ml 以淋巴细胞为主（50%）的血性液体，抗酸杆菌涂片和结核分枝杆菌聚合酶链反应均为阳性。放置了胸腔引流管，并排出了另外 1250ml 血性渗出物。我们用常规抗结核药物治疗该患者，除治疗前存在的支气管扩张外，无其他并发症，感染得到解决。我们认为，达比加群酯和大剂量阿司匹林的联合应用增加了该结核性胸膜炎患者发生胸膜出血的风险。
