[Biventricular thrombi dissolution and antibody development with lepirudin therapy].
METHODS
A 50-year-old patient presented with clinical symptoms of heart failure with orthopnoe and edema (NYHA IV).


METHODS
Echocardiography revealed a dilated left ventricle with severely reduced left ventricular function and biventricular floating thrombi, due to dilatative cardiomyopathy.


METHODS
With a heart failure medication clinical symptoms reduced and body weight decreased > 10 kg in 3 weeks. Due to the high-risk constellation, anticoagulation was performed with lepirudin and the biventricular thrombi were dissolved within 17 days. At this point in time, the patient suffered from petechial bleedings, hemoptysis and gross hematuria. Despite breaking anticoagulation and substitution of PPSB with not measurable fibrinogen, subarachnoid hemorrhage occurred leading to exitus letalis.


CONCLUSIONS
Lepirudin is a highly effective anticoagulant, that can induce severe hemorrhagic side effects in individual cases. The present case report demonstrates an immunological reaction as a rare cause with activation of prothrombin and formation of fibrin.
Skowasch
D
D
Medizinische Klinik und Poliklinik II, Universitätsklinikum Bonn. Dirk.Skowasch@ukb.uni-bonn.de
Pötzsch
B
B
Kuntz-Hehner
S
S
Gampert
T
T
Rox
J
J
Omran
H
H
Bauriedel
G
G
Lüderitz
B
B
D000917:Antibody Formation / Q000276:immunology*; D002311:Cardiomyopathy, Dilated / Q000150:complications / Q000000981:diagnostic imaging / Q000188:drug therapy / Q000276:immunology; D004305:Dose-Response Relationship, Drug; D004452:Echocardiography; D017809:Fatal Outcome; D005343:Fibrinolytic Agents / Q000008:administration & dosage* / Q000009:adverse effects / Q000276:immunology; D006333:Heart Failure / Q000150:complications / Q000000981:diagnostic imaging / Q000188:drug therapy / Q000276:immunology; D006352:Heart Ventricles / Q000000981:diagnostic imaging / Q000276:immunology; D006417:Hematuria / Q000139:chemically induced / Q000276:immunology; D006469:Hemoptysis / Q000139:chemically induced / Q000276:immunology; D006629:Hirudins / Q000008:administration & dosage* / Q000009:adverse effects / Q000031:analogs & derivatives* / Q000276:immunology; D006801:Humans; D008297:Male; D008875:Middle Aged; D011517:Prothrombin Time; D011693:Purpura / Q000139:chemically induced / Q000276:immunology; D011994:Recombinant Proteins / Q000008:administration & dosage* / Q000009:adverse effects / Q000276:immunology; D013345:Subarachnoid Hemorrhage / Q000139:chemically induced / Q000276:immunology; D013927:Thrombosis / Q000000981:diagnostic imaging / Q000188:drug therapy* / Q000276:immunology
D005343:Fibrinolytic Agents; D006629:Hirudins; D011994:Recombinant Proteins; C083544:lepirudin