title: Acute myocardial infarction during thrombolysis of mechanical aortic valve thrombosis associated with heparin-induced thrombocytopenia.
abstract: We report a case of a 60-year-old man with obstructive aortic prosthetic valve thrombosis (APVT). He was treated with low-dose (25 mg) slow infusion (6 hours) of intravenous tissue plasminogen activator (t-PA), and he suffered acute anterior myocardial infarction (MI) at the fourth hour of t-PA infusion. Infusion was kept on, and coronary reperfusion and successful lysis of APVT were achieved. Intravenous unfractionated heparin (UFH) was then started, however, on the third day following heparin treatment, heparin-induced thrombocytopenia (HIT) was recognized by a drop in the platelet count and rethrombosis of the prosthetic valve. Although no nonheparin anticoagulant was available, intravenous continuous infusion of streptokinase (SKZ) 250,000 U per day was administered for 5 days followed by transition to warfarin therapy. Successful lysis of the APVT was again achieved with this regimen and the patient was discharged after uneventful recovery. The patient remained well at 6 months and 1 year follow-up.
authors.affiliation: Department of Cardiology, Kosuyolu Kartal Heart Training and Research Hospital, Istanbul, Turkey.
authors.forename: Sabahattin
authors.initials: S
authors.lastname: Gündüz
authors.forename: Mehmet
authors.initials: M
authors.lastname: Ozkan
authors.forename: Murat
authors.initials: M
authors.lastname: Biteker
authors.forename: Nilüfer Eksi
authors.initials: NE
authors.lastname: Duran
authors.forename: Tahsin
authors.initials: T
authors.lastname: Güneysu
mesh_terms: D001021:Aortic Valve; D005343:Fibrinolytic Agents / Q000008:administration & dosage / Q000009:adverse effects*; D006350:Heart Valve Prosthesis; D006493:Heparin / Q000008:administration & dosage / Q000009:adverse effects*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000209:etiology / Q000628:therapy; D013921:Thrombocytopenia / Q000139:chemically induced* / Q000188:drug therapy*; D015912:Thrombolytic Therapy / Q000009:adverse effects*; D013927:Thrombosis / Q000188:drug therapy*; D010959:Tissue Plasminogen Activator / Q000008:administration & dosage
chemical_list: D005343:Fibrinolytic Agents; D006493:Heparin; D010959:Tissue Plasminogen Activator