title: Diffuse alveolar hemorrhage associated with low molecular weight heparin and dual anti-platelet therapy after percutaneous coronary intervention.
abstract: A 54-year-old man underwent percutaneous coronary intervention (PCI) and two stents were placed on left anterior coronary artery and circumflex artery. Low molecular weight heparin (LMWH) together with ticagrelor 90 mg twice a day and acetylsalicylic acid (Aspirin) were started after PCI due to high risk of stent thrombosis. On the fourth day of patient's follow-up in the intensive care unit (ICU), bloody secretion was started from endotracheal tube. Hemoglobin dropping, bilateral infiltration on the chest X-ray and bleeding from lung were diagnosed as diffuse alveolar hemorrhage (DAH). Apart from LMWH and antiplatelet therapies with aspirin and ticagrelor, there were no other identified risk factors for DAH. As far as we know, our report is the first case of DAH caused by LMWH and dual anti-platelet therapy including ticagrelor.
authors.affiliation: Intensive Care Training Program, Department of Pulmonary Medicine, Gazi University Faculty of Medicine, Ankara, Turkey.
authors.forename: Fatma
authors.initials: F
authors.lastname: Yıldırım
authors.affiliation: Intensive Care Training Program, Department of Anestesiology and Reanimation, Gazi University Faculty of Medicine, Ankara, Turkey.
authors.forename: İskender
authors.initials: İ
authors.lastname: Kara
authors.affiliation: Cardiology Clinic, Isparta State Hospital, Isparta, Turkey.
authors.forename: Hızır
authors.initials: H
authors.lastname: Okuyan
authors.affiliation: Department of Cardiology, Gazi University Faculty of Medicine, Ankara, Turkey.
authors.forename: Adnan
authors.initials: A
authors.lastname: Abacı
authors.affiliation: Intensive Care Unit, Department of Internal Medicine, Gazi University Faculty of Medicine, Ankara, Turkey.
authors.forename: Melda
authors.initials: M
authors.lastname: Türkoğlu
authors.affiliation: Intensive Care Unit, Department of Internal Medicine, Gazi University Faculty of Medicine, Ankara, Turkey.
authors.forename: Gülbin
authors.initials: G
authors.lastname: Aygencel
mesh_terms: D000241:Adenosine / Q000008:administration & dosage / Q000009:adverse effects / Q000031:analogs & derivatives / Q000627:therapeutic use; D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000009:adverse effects; D001241:Aspirin / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use; D004359:Drug Therapy, Combination; D017809:Fatal Outcome; D006470:Hemorrhage / Q000139:chemically induced* / Q000000981:diagnostic imaging; D006495:Heparin, Low-Molecular-Weight / Q000009:adverse effects* / Q000627:therapeutic use; D006801:Humans; D008297:Male; D008875:Middle Aged; D062645:Percutaneous Coronary Intervention / Q000295:instrumentation* / Q000379:methods; D010975:Platelet Aggregation Inhibitors / Q000009:adverse effects* / Q000627:therapeutic use; D011650:Pulmonary Alveoli / Q000098:blood supply* / Q000000981:diagnostic imaging / Q000473:pathology; D058921:Purinergic P2Y Receptor Antagonists / Q000009:adverse effects; D012307:Risk Factors; D015607:Stents / Q000592:standards; D013927:Thrombosis / Q000188:drug therapy* / Q000517:prevention & control; D000077486:Ticagrelor
chemical_list: D000894:Anti-Inflammatory Agents, Non-Steroidal; D006495:Heparin, Low-Molecular-Weight; D010975:Platelet Aggregation Inhibitors; D058921:Purinergic P2Y Receptor Antagonists; D000077486:Ticagrelor; D000241:Adenosine; D001241:Aspirin
keywords: antithrombotic therapy; diffuse alveolar hemorrhage; low molecular weight heparin; percutaneous coronary intervention