Myocardial infarction following t-PA for acute stroke.
OBJECTIVE
Complications of intravenous (IV) thrombolysis with tissue plasminogen activator (t-PA) for acute stroke are commonly related to hemorrhage, anaphylaxis, or arterial re-occlusion. Embolic complications of t-PA are beginning to be recognized with increased use of t-PA for acute ischemic stroke. We hypothesize that disruption of intra-cardiac thrombus may result in myocardial infarction (MI) after use of t-PA for acute ischemic stroke.


METHODS
We describe three cases of acute MI immediately following IV t-PA infusion for acute stroke. In patient #1 apical thrombus was visualized on cardiac echocardiogram accounting for the MI after t-PA for acute stroke. Patient #2 had fresh thrombus seen on cardiac catherization after use of t-PA for acute stroke. Patient #3 developed a significant troponin rise 15 hours after the t-PA for stroke infusion with an echocardiogram revealing new wall motion abnormalities. Patient # 1 and #2 died secondary to multi-organ failure.


CONCLUSIONS
Acute MI immediately following t-PA treatment for stroke is a rare but serious complication. The disruption of intra-cardiac thrombus and subsequent embolization to the coronary arteries may be an important mechanism in the development of MI after t-PA treatment for acute ischemic stroke.
Beth Israel Deaconess Medical Center, Stroke Division, Harvard Medical School, Boston, MA 02215, USA.
M
M
Mehdiratta
C
C
Murphy
A
A
Al-Harthi
P A
PA
Teal
D000368:Aged; D000369:Aged, 80 and over; D003328:Coronary Thrombosis / Q000150:complications; D005260:Female; D005343:Fibrinolytic Agents / Q000009:adverse effects*; D006801:Humans; D008875:Middle Aged; D009203:Myocardial Infarction / Q000139:chemically induced*; D020521:Stroke / Q000150:complications / Q000188:drug therapy*; D013927:Thrombosis / Q000473:pathology; D010959:Tissue Plasminogen Activator / Q000009:adverse effects*
D005343:Fibrinolytic Agents; D010959:Tissue Plasminogen Activator