Acute myocardial infarction after batroxobin treatment of sudden sensorineural hearing loss: Case report

Abstract

Rationale: The drug batroxobin is utilized to enhance microcirculation by reducing fibrinogen levels, making it a treatment option for the acute stage of severe sudden sensorineural hearing loss (SSNHL). However, the efficacy of batroxobin defibrination remains controversial. It is crucial to also consider the potential thrombotic effects of batroxobin. This is the first report of acute myocardial infarction (AMI) in patients after treatment for SSNHL with batroxobin, aiming to enhance its clinical safety profile.

Patient concerns: A 61-year-old male patient presented with severe SSNHL in the left ear. During hospitalization, the plasma fibrinogen level remained consistently low following batroxobin treatment and subsequently led to AMI.

Diagnoses: SSNHL, AMI.

Interventions: Percutaneous coronary intervention surgery confirmed thrombus blockage in the middle segment of the right coronary artery, and the symptoms were relieved after thrombus removal.

Outcomes: The patient was discharged from the hospital on the 5th day after surgery without any recurrence of AMI up to now.

Lessons: The pharmacology and toxicity of batroxobin are intricate, necessitating careful consideration of potential secondary thrombosis during treatment, particularly regarding fibrinogen levels.

Keywords: acute myocardial infarction; batroxobin; fibrinogen; sudden sensorineural hearing loss; thrombosis.

Figure 1.

Throughout hospitalization, plasma fibrinogen monitoring revealed a consistently low level of fibrinogen (<1 g/L) following the initial administration of batroxobin 10BU, and subsequent occurrence of AMI after the second dose of batroxobin 5BU. AMI = acute myocardial infarction.

Figure 2.

(A) Complete occlusion of the mid-segment of the right coronary stent is observed (indicated by the yellow arrow). (B) Blood vessel patency is restored after thrombus removal.

Figure 3.

The total score of ≥ 9 indicates a positive causal relationship between the drug and adverse reactions. The total score of 5 to 8 suggests a likely relevance, supported by objective evidence or quantitative test results. The total score of 1 to 4 may indicate some relevance that cannot be fully confirmed or completely denied. An overall score of 0 or less is classified as suspicious, incidental, or largely irrelevant.