Respir Case Rep. 2017; 6(3): 149-152 | DOI: 10.5505/respircase.2017.65002

Prasugrel Kullanýrken Trombolitik Tedavi Uygulanan Masif Pulmoner Emboli Olgusu

Ayþe Baha¹, Reþat Mehmet Baha², Ýbrahim Yýldýz^3
1Ufuk Üniversitesi Týp Fakültesi, Göðüs Hastalýklarý Anabilim Dalý, Ankara
²Medicalpark Hastanesi, Kardiyoloji Kliniði, Ankara
³Osmaniye Devlet Hastanesi, Kardiyoloji Kliðini, Osmaniye

Elli beþ yaþýnda, koroner arter hastalýðý nedeni ile prasugrel ve asetilsalisilik asit kullanmakta olan kadýn hasta, senkop ve hipotansiyon ile acile servise getirildi. Ekokardiyografide paradoks septum ve sað ventrikülde geniþleme saptanan, kontrastlý bilgisayarlý toraks tomografisinde bilateral ana pulmoner arterlerde ve dallarýnda yaygýn trombüs görülen hastaya rt-PA uygulandý. Trombolitik bitiminde heparinize edilen hastanýn tedavisine yirmi dördüncü saatte warfarin eklendi. Kanama komplikasyonu geliþmeyen hasta yedinci günde warfarin, klopidogrel, asetilsalisilikasit tedavileri altýnda taburcu edildi. Bu olgu, yeni kuþak antitrombotik olan presugrelin kanama riskinin yüksek olmasý, bu ilaç ile birlikte daha önce trombolitik kullanýmýnýn bildirilmemiþ olmasý, sonuçta kanama komplikasyonu geliþmeden hastanýn takip edilmesi açýsýndan önemlidir.

Anahtar Kelimeler: Masif Pulmoner Emboli, Prasugrel, Trombolitik Tedavi

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Administration of Thrombolytic Treatment for Massive Pulmonary Embolism in A Patient on Prasugrel

Ayþe Baha¹, Reþat Mehmet Baha², Ýbrahim Yýldýz^3
1Department of Pulmonary Medicine, Ufuk University Faculty of Medicine, Ankara, Turkey
²Department of Cardiology, Medicalpark Hospital, Ankara, Turkey
³Department of Cardiology, Osmaniye State Hospital, Osmaniye, Turkey

A 55-year-old female patient was admitted to emergency service for hypotension and syncope. The patient was under dual antiplatelet therapy, aspirin, and prasugrel for coronary artery disease. Echocardiography revealed dilated right heart chambers as well as paradoxical septal motion, suggesting a diagnosis of pulmonary embolism. Thorax computerized tomography with contrast enhancement was performed and revealed thrombi in both main pulmonary arteries and their branches. Thrombolytic treatment was provided. There were no bleeding complications, and patient was discharged from the hospital on the seventh day, taking warfarin, clopidogrel, and aspirin. The present case is important because thrombolytic treatment for a patient who is on prasugrel has not been reported in the literature previously, and it illustrates that such therapy can be administered safely, though prasugrel has been associated with an increased rate of bleeding complications.

Keywords: Massive Pulmonary Embolism, Prasugrel, Thrombolytic Treatment

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ATIF KOPYALA