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Spontaneous Mediastinal Hemorrhage: A Complication of Intracoronary Streptokinase Infusion for Coronary Thrombosis

Spontaneous Mediastinal Hemorrhage: A Complication of Intracoronary Streptokinase Infusion for... Abstract • A 72-year-old man with a recent inferior-wall myocardial infarction complicated by continued ischemic cardiac pain underwent an intracoronary streptokinase infusion in an attempt to re-establish coronary perfusion. Although the cardiac catheterization and streptokinase infusion were technically uncomplicated, signs of an enlarging mediastinal mass associated with a drop in the hematocrit reading developed in the patient 12 hours after the procedure. Aortography showed no evidence of aortic dissection or laceration. The patient was believed to have a spontaneous mediastinal hemorrhage related to streptokinase infusion. (Arch Intern Med 1983;143:562-563) References 1. Mant MJ, O'Brien BD, Thong KL, et al: Hemorrhagic complications of heparin therapy. Lancet 1977;1:1133-1135.Crossref 2. Urokinase pulmonary embolism trial: Phase I. JAMA 1970;214:2163-2172.Crossref 3. Kelton JG, Hirsh J: Bleeding associated with antithrombotic therapy. Semin Hematol 1980;17:259-291. 4. Urokinase streptokinase embolism trial: Phase II. JAMA 1974;229: 1606-1613.Crossref 5. Sparacia A, Di Chiara A: Complicanze della terapia anticoagulante e trombolitica. Minerva Anestesiol 1981;47;115-122. 6. Vieweg WV, Piscatelli RL, Houser JJ, et al: Complications of intravenous administration of heparin in elderly women. JAMA 1970;213: 1303-1306.Crossref 7. European Working Party: Streptokinase in recent myocardial infarction: Controlled multicentre trial. Br Med J 1971;3:325-331.Crossref 8. Persson AV: Fibrinolytic therapy. Compr Ther 1980;6:12-17. 9. Shrier SL, Sasahara AA, Wall RT, et al: The use of fibrinolytic agents. West J Med 1981;1341:128-133. 10. Ducker F: Thrombolytic therapy in myocardial infarction. Prog Cardiovasc Dis 1979;21:342-350.Crossref 11. Merx W, Dorr R, Rentrop P, et al: Evaluation of the effectiveness of intracoronary streptokinase infusion in acute myocardial infarction: Post-procedure management and hospital course in 204 patients. Am Heart J 1981;102:1181-1187.Crossref 12. Eshaghy B, Loeb HS, Miller SE, et al: Mediastinal and retropharyngeal hemorrhage: A complication of cardiac catheterization. JAMA 1973;226:427-431.Crossref 13. Swan HJC: Hemorrhage. Circulation 1968;37( (suppl 3) ):52-53. 14. Lang ET: A survey of the complications of percutaneous retrograde arteriography. Radiology 1963;81:257-263.Crossref 15. Turetz F, Stineberg H, Kahn A: Spontaneous anterior mediastinal hematoma: A complication of heparin therapy. J Am Med Worn Assoc 1979;34:85-88. 16. Epstein AM, Klassen KP: Spontaneous superior mediastinal hemorrhage. J Thorac Cardiovasc Surg 1960;39:740-745. http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Archives of Internal Medicine American Medical Association

Spontaneous Mediastinal Hemorrhage: A Complication of Intracoronary Streptokinase Infusion for Coronary Thrombosis

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Publisher
American Medical Association
Copyright
Copyright © 1983 American Medical Association. All Rights Reserved.
ISSN
0003-9926
eISSN
1538-3679
DOI
10.1001/archinte.1983.00350030176031
Publisher site
See Article on Publisher Site

Abstract

Abstract • A 72-year-old man with a recent inferior-wall myocardial infarction complicated by continued ischemic cardiac pain underwent an intracoronary streptokinase infusion in an attempt to re-establish coronary perfusion. Although the cardiac catheterization and streptokinase infusion were technically uncomplicated, signs of an enlarging mediastinal mass associated with a drop in the hematocrit reading developed in the patient 12 hours after the procedure. Aortography showed no evidence of aortic dissection or laceration. The patient was believed to have a spontaneous mediastinal hemorrhage related to streptokinase infusion. (Arch Intern Med 1983;143:562-563) References 1. Mant MJ, O'Brien BD, Thong KL, et al: Hemorrhagic complications of heparin therapy. Lancet 1977;1:1133-1135.Crossref 2. Urokinase pulmonary embolism trial: Phase I. JAMA 1970;214:2163-2172.Crossref 3. Kelton JG, Hirsh J: Bleeding associated with antithrombotic therapy. Semin Hematol 1980;17:259-291. 4. Urokinase streptokinase embolism trial: Phase II. JAMA 1974;229: 1606-1613.Crossref 5. Sparacia A, Di Chiara A: Complicanze della terapia anticoagulante e trombolitica. Minerva Anestesiol 1981;47;115-122. 6. Vieweg WV, Piscatelli RL, Houser JJ, et al: Complications of intravenous administration of heparin in elderly women. JAMA 1970;213: 1303-1306.Crossref 7. European Working Party: Streptokinase in recent myocardial infarction: Controlled multicentre trial. Br Med J 1971;3:325-331.Crossref 8. Persson AV: Fibrinolytic therapy. Compr Ther 1980;6:12-17. 9. Shrier SL, Sasahara AA, Wall RT, et al: The use of fibrinolytic agents. West J Med 1981;1341:128-133. 10. Ducker F: Thrombolytic therapy in myocardial infarction. Prog Cardiovasc Dis 1979;21:342-350.Crossref 11. Merx W, Dorr R, Rentrop P, et al: Evaluation of the effectiveness of intracoronary streptokinase infusion in acute myocardial infarction: Post-procedure management and hospital course in 204 patients. Am Heart J 1981;102:1181-1187.Crossref 12. Eshaghy B, Loeb HS, Miller SE, et al: Mediastinal and retropharyngeal hemorrhage: A complication of cardiac catheterization. JAMA 1973;226:427-431.Crossref 13. Swan HJC: Hemorrhage. Circulation 1968;37( (suppl 3) ):52-53. 14. Lang ET: A survey of the complications of percutaneous retrograde arteriography. Radiology 1963;81:257-263.Crossref 15. Turetz F, Stineberg H, Kahn A: Spontaneous anterior mediastinal hematoma: A complication of heparin therapy. J Am Med Worn Assoc 1979;34:85-88. 16. Epstein AM, Klassen KP: Spontaneous superior mediastinal hemorrhage. J Thorac Cardiovasc Surg 1960;39:740-745.

Journal

Archives of Internal MedicineAmerican Medical Association

Published: Mar 1, 1983

References