| Sign In to gain access to subscriptions and/or personal tools. |
Haematoma of the Hand as a Complication of Thrombolysis for Myocardial InfarctionDepartment of Orthopaedics and Trauma and Department of Cardiology, Conquest Hospital, St Leonards-on-Sea, TN37 7UY, UK E-mail: kahmed198{at}yahoo.co.uk Dear Sir, A 72 year-old woman presented with an anterior myocardial infarction and received thrombolysis with Tenecteplase followed by intravenous Heparin infusion. Two days later, she complained of a gradual-onset of painful swelling of her right hand. This had started as a bruise soon after insertion of an intravenous cannula on the dorsal aspect of this hand (Fig 1), although the thrombolytic drugs were administrated through the contralateral antecubital vein. On examination, the dorsum of the right hand was as shown in Figure 1 with the viability of the skin threatened. The radial and ulnar pulses were present. Sensation was reduced in the distribution of the median nerve. With a normal coagulation profile, the compartments of the hand and the carpal tunnel were decompressed under general anaesthesia. A large amount of blood and haematoma under the skin was drained, restoring the viability of the overlying skin, and the wound edges were approximated. At three month follow-up, her wounds had healed well with excellent and full recovery of hand function.
The indications for thrombolysis are wide-ranging and include treatment of acute ischaemic stroke, massive pulmonary embolism, prosthetic heart valve thrombosis, central venous catheter occlusion, acute limb arterial occlusion and pedicle thrombosis for free-flap salvage (Rinker et al., 2007). Its commonest use worldwide is in the management of acute ST-segment elevation myocardial infarction. Bleeding is the most common complication of this treatment, occurring in up to 20% of cases (McLeod et al., 1993), and mostly occurs at the sites of vascular access, although vocal cord haematoma (Samimi-Fard et al., 2006) and submandibular haematoma associated with airway compromise (Kirkham et al., 2006) have been reported. Any invasive procedure, minor or major, can provoke significant haemorrhage. Tenecteplase, a mutant of tissue plasminogen activator, is believed to have greater fibrin-specificity than traditional agents, such as Streptokinase, and, thus, theoretically less risk of inducing bleeding, as well as the advantage of being administered by simple bolus injection (Dunn and Goa, 2001).
Dunn CJ, Goa KL (2001). Tenecteplase: a review of its pharmacology and therapeutic efficacy in patients with acute myocardial infarction. The American Journal of Cardiovascular Drugs, 1: 51–66.[CrossRef] Kirkham L, Homewood J, Brook P (2006). Case of the month: a case of airway obstruction following tenecteplase administration. Emergency Medical Journal, 23: 815–816. McLeod DC, Colon WG, Thayer CF et al (1993). Pharmacoepidemiology of bleeding events after use of r-alteplase or streptokinase in acute myocardial infarction. Annals of Pharmacotherapy, 27: 956–962.[Abstract] Rinker BD, Stewart DH, Pu LL, Vasconez HC (2007). Role of recombinant tissue plasminogen activator in free flap salvage. Journal of Reconstructive Microsurgery, 23: 69–73.[CrossRef][Web of Science][Medline] [Order article via Infotrieve] Samimi-Fard S, Garcia-Gonzalez M, Dominguez-Rodriguez A (2006). Vocal cord haematoma after tenecteplase thrombolysis. Acta Oto-Laryngologica, 126: 884–885.[CrossRef][Medline] [Order article via Infotrieve]
Journal of Hand Surgery (European Volume), Vol. 32, No. 6,
720-721 (2007)
|
|||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
 |
|
|
 |
|
Sign In to gain access to subscriptions and/or personal tools.
Top
References