Reactions 1680, p150 - 2 Dec 2017 Bleeding during surgery: case report A 60-year-old woman developed fatal bleeding during treatment with gefitinib. The woman, who had been diagnosed with stage IIIA nonsmall cell lung carcinoma 8 years previously, was hospitalised with complaints of chest pain. She had been receiving chemotherapy with gefitinib [route and dosage not stated] along with aspirin, metoprolol, iron and vitamin- B12-analogues [vitamin B12]. After admission, her chest radiograph revealed left perihilar parenchymal scars, surgical clips and postoperative changes in the chest. Subsequently, she underwent exercise nuclear stress test which revealed indeterminate ECG changes and a small artifactual anteroseptal wall defect. After undergoing the stress test, she complained of retrosternal chest pain. Her serum troponin level was noted to be increased. Subsequently, coronary angiography revealed 90% stenosis of the left main coronary artery ostium, which was described as radiation induced coronary artery disease (RICAD). A coronary artery bypass graft/surgical revascularisation was planned. Overnight, she suffered with intense anginal chest pain without any elevation in cardiac enzymes. Therefore, the surgery was initiated. During the surgery, dense adhesions surrounding the heart were observed. She developed severe bleeding from the adhesions [duration of treatment to reaction onset not stated]. The woman underwent aggressive transfusion of RBCs and platelets. However, the bleeding was uncontrollable and she died during surgery. Author comment: "[O]ur patient was receiving the gefitinib, a chemotherapeutic agent which decreases platelet function via prostaglandin and thrombaxene and increases the bleeding risk." "She went to the operating room for CABG due to recurrent unstable angina but developed fatal bleeding related to side effects of both radiation and chemotherapy." Alsara O, et al. Isolated left main coronary artery stenosis after thoracic radiation therapy: To operate or not to operate. Case Reports in Medicine 2013: 2013. Available from: URL: http://doi.org/10.1155/2013/834164 - USA 803284031 0114-9954/17/1680-0001/$14.95 Adis © 2017 Springer International Publishing AG. All rights reserved Reactions 2 Dec 2017 No. 1680
Reactions Weekly – Springer Journals
Published: Dec 2, 2017
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