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Case Reports
. 2022 Nov 24:40:101782.
doi: 10.1016/j.rmcr.2022.101782. eCollection 2022.

Pulmonary hemorrhage in patients receiving anti-platelets- a case series and a suggested therapeutic algorithm

Ioannis Tomos  1 , Maria Kallieri  1 , Andriana I Papaioannou  1 , Eleni Stagaki  1 , Thomas Raptakis  1 , Anna Karakatsani  1 , Panagiotis Korkonikitas  2 , Effrosyni D Manali  1 , Vagia Karageorgou  1 , Myrto Mplizou  1 , Katerina Vlami  1 , Stelios Loukides  1 , Spyros Papiris  1
Affiliations
Case Reports

Pulmonary hemorrhage in patients receiving anti-platelets- a case series and a suggested therapeutic algorithm

Ioannis Tomos et al. Respir Med Case Rep. .

Abstract

Antiplatelet therapy including aspirin and thienopyridine agents (such as clopidogrel, prasugrel and ticagrelor) are often used in patients with coronary disease. Pulmonary hemorrhage due to antiplatelet therapy although very rare, when excessive, is a life-threatening event. So far, there is lack of specific guidelines for the management of these patients. We report a case series of 5 patients receiving antiplatelet therapy who were admitted to the hospital due to pulmonary hemorrhage related to antiplatelet therapy. We also propose an algorithm on the management of these patients taking into consideration the balance between thrombotic and bleeding risk and the severity of the hemorrhage.

Keywords: ADP, Thienopyridine adenosine diphosphate; Algorithm; Antiplatelet therapy; BAL, Broncho-alveolar lavage; COX-1, Cyclooxygenase-1; CT, Computerized tomography; ENT, Otolaryngologist; Hemoptysis; LRTI, Lower respiratory tract infection; Pulmonary hemorrhage.

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Figures

Fig. 1
Fig. 1
Chest computerized tomography (CT) angiography showing ground glass opacities in both lower lobes.
Fig. 2
Fig. 2
Chest CT angiography revealed bronchiectasis in the middle lobe, the lingula and the left lower lobe.
Fig. 3A
Fig. 3A
Chest CT angiography depicted enlargement of the right bronchial artery.
Fig. 3B
Fig. 3B
Chest CT showed ground glass opacities in the right lower lobe and enlargement of the right bronchial artery (black arrow).
Fig. 4
Fig. 4
Chest CT angiography revealed ground glass opacities at the right upper lobe.
Fig. 5
Fig. 5
Algorithmic approach for the management of pulmonary hemorrhage in patients receiving antiplatelets.
See this image and copyright information in PMC

References

    1. Valgimigli M., et al. ESC focused update on dual antiplatelet therapy in coronary artery disease developed in collaboration with EACTS: the Task Force for dual antiplatelet therapy in coronary artery disease of the European Society of Cardiology (ESC) and of the European Association for Cardio-Thoracic Surgery (EACTS) Eur. Heart J. 2017;39(3):213–260. 2018. - PubMed
    1. Roy P., et al. Impact of "nuisance" bleeding on clopidogrel compliance in patients undergoing intracoronary drug-eluting stent implantation. Am. J. Cardiol. 2008;102(12):1614–1617. - PubMed
    1. Ohkubo K., et al. Incidence of side-effects of dual antiplatelet therapy with clopidogrel and aspirin after coronary stent implantation. Cardiovasc. Interv. Ther. 2011;26(1):33–37. - PubMed
    1. Fernández-Perez G.C., et al. Pulmonary hemorrhage in a patient with acute coronary syndrome. AJR Am. J. Roentgenol. 2007;189(3):W135–W137. - PubMed
    1. Sakr L., Dutau H. Massive hemoptysis: an update on the role of bronchoscopy in diagnosis and management. Respiration. 2010;80(1):38–58. - PubMed

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