Tenecteplase for ST-elevation.pdfVIP

BioMed Central ss Journal of Medical Case ReportsOpen AcceCase report Tenecteplase for ST-elevation myocardial infarction in a patient treated with drotrecogin alfa (activated) for severe sepsis: a case report Lillian Barra1, Jeffrey Shum1, J Geoffrey Pickering2 and Raymond Kao*1 Address: 1Division of Critical Care, Department of Medicine, University of Western Ontario, Commissioners Rd, London, Ontario, Canada and 2Division of Cardiology, Department of Medicine, University of Western Ontario, Commissioners Rd, London, Ontario, Canada Email: Lillian Barra - lbarra@uwo.ca; Jeffrey Shum - Jeffrey.Shum@londonhospitals.ca; J Geoffrey Pickering - gpickering@robarts.ca; Raymond Kao* - rkao3@uwo.ca * Corresponding author Abstract Introduction: Drotrecogin alfa (activated) (DrotAA), an activated protein C, promotes fibrinolysis in patients with severe sepsis. There are no reported cases or studies that address the diagnosis and treatment of myocardial infarction in septic patients treated with DrotAA. Case presentation: A 59-year-old Caucasian man with septic shock secondary to community- acquired pneumonia treated with DrotAA, subsequently developed an ST-elevation myocardial infarction 12 hours after starting DrotAA. DrotAA was stopped and the patient was given tenecteplase thrombolysis resulting in complete resolution of ST-elevation and no adverse bleeding events. DrotAA was restarted to complete the 96-hour course. The sepsis resolved and the patient was discharged from hospital. Conclusion: In patients with severe sepsis or septic shock complicated by myocardial infarction, it is difficult to determine if the myocardial infarction is an isolated event or caused by the sepsis process. The efficacy and safety of tenecteplase thrombolysis in septic patients treated with DrotAA need further study. Introduction Sepsis with multi-organ failure has a high incidence and a mortality rate of 30-50% [1]. The pathophysiology of sep- sis is an inflammatory and procoagulant