We describe a 66-year-old patient with hemoptysis, a drop in hematocrit, hypoxemia and new bilateral alveolar infiltrates after receiving streptokinase for acute myocardial infarction. Markedly increased carbon monoxide diffusion capacity suggested a diagnosis of alveolar hemorrhage. Underlying conditions included congestive heart failure. The patient recovered uneventfully within 7 days of conservative treatment. Alveolar hemorrhage is a rare and often unrecognized life-threatening complication of thrombolytic therapy. Particular attention should be paid to the pulmonary status of patients with congestive heart failure scheduled to receive thrombolytic therapy.

Keywords:
Diffuse alveolar hemorrhage, Fibrinolytic-thrombolytic therapy, Myocardial infarction
1.
Anderson HV, Willerson JT: Thrombolysis in acute myocardial infarction. N Engl J Med 1993;329:703–709.
2.
Task Force on the Management of Acute Myocardial Infarction of the European Society of Cardiology: Acute myocardial infarction: Pre-hospital and in-hospital management. Eur Heart J 1996;17:43–63.
3.
Chang YC, Patz EF, Goodman PC, Granger CB: Significance of hemoptysis following thrombolytic therapy for acute myocardial infarction. Chest 1996;109:727–729.
4.
Disler LJ, Rosendorff A: Pulmonary hemorrhage following intravenous streptokinase for acute myocardial infarction. Int J Cardiol 1990;29:387–390.
5.
Nathan PE, Torres AV, Smith AJ, Gagliardi AJ, Rapeport KB: Spontaneous pulmonary hemorrhage following coronary thrombolysis. Chest 1992;101:1150–1152.
6.
Cuellar Obispo E, Torrado Gonzalez E, Alvarez Bueno M, Ferriz Martin A, et al: A diffuse pulmonary hemorrhage following thrombolytic therapy in an acute myocardial infarct. Rev Esp Cardiol 1992;45:421–424.
7.
Awadh N, Ronco JJ, Bernstein V, Gilks B, Wilcox P: Spontaneous pulmonary hemorrhage after thrombolytic therapy for acute myocardial infarction. Chest 1994;106:1622–1624.
8.
Masip J, Vecilla F, Paez J: Diffuse pulmonary hemorrhage after fibrinolytic therapy for acute myocardial infarction. Int J Cardiol 1998;63:95–97.
9.
Hammoudhea AJ, Haft JI, Eichman GT: Hemoptysis and unilateral intra-alveolar hemorrhage complicating intravenous thrombolytic therapy for myocardial infarction. Clin Cardiol 1996;19:595–596.
10.
Tio RA, Voorbij R, Entoven R: Adult respiratory distress syndrome after streptokinase. Am J Cardiol 1992;70:1632–1635.
11.
Swanson GA, Gurjit K, Geraci GA: Diffuse pulmonary hemorrhage after streptokinase administration for acute myocardial infarction. Clin Cardiol 1997;20:298–300.
12.
Gopalakrishnan D, Tioran T, Emanuel C, Clark VL: Diffuse pulmonary hemorrhage complicating thrombolytic therapy for acute myocardial infarction. Pharmacotherapy 1997;17:390–394.
13.
Green RJ, Ruoss SJ, Kraft SA, Berry GJ, Raffan TA: Pulmonary capillaritis and alveolar hemorrhage. Chest 1996;110:1305–1316.
14.
Levine MN, Goldhaber SZ, Califf RM, Gore JM, Hirsh J: Hemorrhagic complications of thrombolytic therapy in the treatment of myocardial infarction and venous thromboembolism. Chest 1992;102:364–373.
© 2000 S. Karger AG, Basel
2000
Copyright / Drug Dosage / Disclaimer
Copyright: All rights reserved. No part of this publication may be translated into other languages, reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording, microcopying, or by any information storage and retrieval system, without permission in writing from the publisher.
Drug Dosage: The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in government regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any changes in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug.
Disclaimer: The statements, opinions and data contained in this publication are solely those of the individual authors and contributors and not of the publishers and the editor(s). The appearance of advertisements or/and product references in the publication is not a warranty, endorsement, or approval of the products or services advertised or of their effectiveness, quality or safety. The publisher and the editor(s) disclaim responsibility for any injury to persons or property resulting from any ideas, methods, instructions or products referred to in the content or advertisements.
You do not currently have access to this content.