[Between thrombosis and bleeding - a case of paroxysmal nocturnal hemoglobinuria].
A 67-year-old lady was admitted with a myocardial infarction. Coronarography revealed thrombotic material within coronary arteries. The underlying disease was paroxysmal nocturnal hemoglobinuria (PNH), a stem cell defect characterized by episodes of complement-induced hemolysis and thromboembolic events. Anticoagulation and antiaggregation were initiated. Subsequently, massive cerebral bleeding developed, to which the patient finally succumbed despite neurosurgical craniectomy. This tragic case illustrates that an antithrombotic treatment is always a balancing act with an unsecure outcome.
Departement Innere Medizin, Kantonsspital Graubünden, Chur. walter.reinhart@ksgr.ch
Walter H
WH
Reinhart
D000368:Aged; D000925:Anticoagulants / Q000009:adverse effects* / Q000627:therapeutic use*; D001241:Aspirin / Q000009:adverse effects / Q000627:therapeutic use; D002543:Cerebral Hemorrhage / Q000139:chemically induced* / Q000175:diagnosis; D000077144:Clopidogrel; D003328:Coronary Thrombosis / Q000175:diagnosis* / Q000188:drug therapy*; D004359:Drug Therapy, Combination; D017809:Fatal Outcome; D005260:Female; D006457:Hemoglobinuria, Paroxysmal / Q000150:complications* / Q000188:drug therapy*; D006493:Heparin / Q000009:adverse effects / Q000627:therapeutic use; D006495:Heparin, Low-Molecular-Weight / Q000009:adverse effects / Q000627:therapeutic use; D006801:Humans; D010644:Phenprocoumon / Q000009:adverse effects / Q000627:therapeutic use; D010975:Platelet Aggregation Inhibitors / Q000009:adverse effects* / Q000627:therapeutic use*; D013988:Ticlopidine / Q000009:adverse effects / Q000031:analogs & derivatives / Q000627:therapeutic use; D014057:Tomography, X-Ray Computed
D000925:Anticoagulants; D006495:Heparin, Low-Molecular-Weight; D010975:Platelet Aggregation Inhibitors; D006493:Heparin; D000077144:Clopidogrel; D013988:Ticlopidine; D010644:Phenprocoumon; D001241:Aspirin