Retroperitoneal Bleed with Ticagrelor Administration Following Fibrinolytic Therapy in Acute ST-Elevation Myocardial Infarction

Abstract

ST-elevation myocardial infarction, in anticipation of primary percutaneous coronary intervention, clopidogrel, prasugrel or ticagrelor are given with Aspirin on presentation. The Authors report a case of acute ST elevation anterior wall myocardial infarction administered ticagrelor with Asprin with intent to treat by primary percutaneous coronary intervention, but patient subsequently opted for intravenous fibrinolytic therapy instead of primary percutaneous coronary intervention. Although fibrinolytic therapy was successful in achieving reperfusion, patient developed significant retroperitoneal bleed requiring multiple blood transfusions. Only clopidogrel is recommended in the setting of fibrinolytic therapy in the guidelines and no data are presently available with ticagrelor.