Tenecteplase for ST-elevation Myocardial Infarction in a Patient treated with Drotrecogin Alfa (Activated) for Severe Sepsis: A Case Report

Authors

Lillian Barra, University of Western OntarioFollow
Jeffrey Shum, University of Western OntarioFollow
J Geoffrey Pickering, University of Western OntarioFollow
Raymond Kao, University of Western OntarioFollow

Document Type

Article

Publication Date

11-5-2009

Journal

Journal of Medical Case Reports

Volume

3

Issue

109

URL with Digital Object Identifier

10.1186/1752-1947-3-109

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.