Tenecteplase
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Haemorrhagic pericarditis: case report A 69-year-old man developed haemorrhagic pericarditis during treatment with tenecteplase. The man, who had a significant history of hypertension, abdominal aortic aneurysm of 2.7cm, hyperlipidaemia, uncontrolled diabetes and tobacco use (1 pack-year), presented with exertional chest pain. Subsequently, he was diagnosed with ST-segment elevation myocardial infarction (STEMI). He started receiving tenecteplase [dosage and route not stated], along with concomitant clopidogrel and aspirin. A coronary angiography revealed a left-dominant system with a culprit 100% thrombotic occlusion of the left circumflex coronary artery and a non-culprit 90% proximally diseased left anterior descending artery. Because of extensive thrombus burden, a balloon angioplasty was unsuccessful. Subsequently, an intra-aortic balloon pump was inserted. He was transferred to the coronary care unit. Transthoracic echocardiography showed a left ventricular ejection fraction of 25% and a small circumferential pericardial effusion with visible thrombus. Further inquiry revealed that he had been having chest pain for last 6 days, and he was avoiding medical care due to the ongoing pandemic. He was diagnosed with haemorrhagic pericarditis after treatment of the myocardial infarction (MI) with tenecteplase. He continued to receive aspirin, along with ticagrelor for STEMI. On the next day, the intra-aortic balloon pump was removed. His COVID-19 test returned negative. The haemorrhagic pericardial effusion was considered to be secondary to thrombolytic treatment with tenecteplase and an underlying inflamed pericardium. After 6 days, echocardiography showed resolution of haemorrhagic pericardial effusion. Otero D, et al. Complication of Late Presenting STEMI Due to Avoidance of Medical Care During the COVID-19 Pandemic. JACC: Case Reports 2: 1610-1613, No. 10, Aug 803499900 2020. Available from: URL: http://doi.org/10.1016/j.jaccas.2020.05.045
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Reactions 5 Sep 2020 No. 1820
