Spinal epidural hematoma following tissue plasminogen activator and heparinization for acute myocardial infarction.
The case of a 43-year-old Taiwanese man who presented with spinal epidural hematoma following intravenous administration of recombinant tissue plasminogen activator (rTPA) and heparin therapy for acute myocardial infarction (AMI) is reported. Upper back pain and progressive neurological dysfunction ensued, secondary to spinal epidural hematoma with spinal cord compression. The patient did not recover neurologic function postsurgically, possibly because the operation was delayed. In conclusion, cardiologists should be alert to this rare, severe complication of rTPA and should perform early laminectomy (in < or = 36 hours for those with complete deficit and in < or = 48 hours for those with incomplete deficit) if possible.
Chan
Kuei-Chuan
KC
Department of Internal Medicine, Chung-Shan Medical University Hospital, Taichung, Taiwan.
Wu
Der-Jinn
DJ
Ueng
Kwo-Chang
KC
Lin
Cheng-Sheng
CS
Tsai
Chin-Feng
CF
Chen
Kwo-Shuen
KS
Lin
Ming-Cheng
MC
Wang
Kao-Lun
KL
Lin
Chung-Sheng
CS
D000328:Adult; D006407:Hematoma, Epidural, Cranial / Q000139:chemically induced*; D006493:Heparin / Q000008:administration & dosage / Q000009:adverse effects*; D006801:Humans; D008297:Male; D009203:Myocardial Infarction / Q000188:drug therapy*; D011994:Recombinant Proteins / Q000008:administration & dosage / Q000009:adverse effects; D013118:Spinal Cord Diseases / Q000139:chemically induced; D010959:Tissue Plasminogen Activator / Q000008:administration & dosage / Q000009:adverse effects*
D011994:Recombinant Proteins; D006493:Heparin; D010959:Tissue Plasminogen Activator