Tenecteplase for ST-elevation myocardial infarction in a patient treated with drotrecogin alfa (activated) for severe sepsis: a case report.

Journal of Medical Case Reports
Lillian BarraRaymond Kao

Abstract

Drotrecogin alfa (activated) (DrotAA), an activated protein C, promotes fibrinolysis in patients with severe sepsis. There are no reported cases or studies that address the diagnosis and treatment of myocardial infarction in septic patients treated with DrotAA. A 59-year-old Caucasian man with septic shock secondary to community-acquired pneumonia treated with DrotAA, subsequently developed an ST-elevation myocardial infarction 12 hours after starting DrotAA. DrotAA was stopped and the patient was given tenecteplase thrombolysis resulting in complete resolution of ST-elevation and no adverse bleeding events. DrotAA was restarted to complete the 96-hour course. The sepsis resolved and the patient was discharged from hospital. In patients with severe sepsis or septic shock complicated by myocardial infarction, it is difficult to determine if the myocardial infarction is an isolated event or caused by the sepsis process. The efficacy and safety of tenecteplase thrombolysis in septic patients treated with DrotAA need further study.

References

Jan 11, 1995·JAMA : the Journal of the American Medical Association·M S Rangel-FraustoR P Wenzel
Mar 10, 2001·The New England Journal of Medicine·G R BernardUNKNOWN Recombinant human protein C Worldwide Evaluation in Severe Sepsis (PROWESS) study group
Oct 3, 2002·Current Opinion in Critical Care·Sreenandh KrishnagopalanAnand Kumar
Jun 12, 2003·Journal of the American College of Cardiology·Peter AmmannThomas Fehr
Oct 18, 2005·BMC Emergency Medicine·Christian J Wiedermann, Nicole C Kaneider

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Methods Mentioned

BETA
X-ray
tissue

Software Mentioned

DrotAA

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