Cholesterol Embolisation After Thrombolytic Therapy

Overview

Journal Drug Saf

Specialties Pharmacology
Toxicology

Date 1996 Feb 1

PMID 8852522

Citations 2

Authors

J C Blankenship

Affiliations

Soon will be listed here.

Abstract

Cholesterol embolisation has been reported in 27 patients receiving thrombolytic therapy for acute myocardial infarction (MI). Since cholesterol embolisation is so difficult to diagnose ante mortem, it is possible that these cases represent the 'tip of the iceberg', and that cholesterol embolisation in this setting is far more common than usually suspected. However, the risks of cholesterol embolisation are far outweighed by the survival benefits of thrombolytic therapy in patients with MI. Nevertheless, clinicians should maintain a high level of suspicion when clinical manifestations suggestive of cholesterol embolisation appear after thrombolytic therapy, as the risk of morbidity and mortality can be high.

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References

RETAN J, Miller R . Microembolic complications of atherosclerosis. Literature review and report of a patient. Arch Intern Med. 1966; 118(6):534-45. View

Gupta B, Spinowitz B, Charytan C, Wahl S . Cholesterol crystal embolization-associated renal failure after therapy with recombinant tissue-type plasminogen activator. Am J Kidney Dis. 1993; 21(6):659-62. DOI: 10.1016/s0272-6386(12)80040-0. View

Diethelm A, Vorburger C, Anabitarte M, Haag E . [Cholesterol crystal embolisms due to systemic thrombolysis of an acute myocardial infarct]. Schweiz Med Wochenschr. 1994; 124(33):1437-41. View

Ridker P, Michel T . Streptokinase therapy and cholesterol embolization. Am J Med. 1989; 87(3):357-8. DOI: 10.1016/s0002-9343(89)80170-6. View

Blair N, Hayes G . Perforation of the small bowel: a case report. Can J Surg. 1995; 38(3):281-2. View

. GISSI-2: a factorial randomised trial of alteplase versus streptokinase and heparin versus no heparin among 12,490 patients with acute myocardial infarction. Gruppo Italiano per lo Studio della Sopravvivenza nell'Infarto Miocardico. Lancet. 1990; 336(8707):65-71. View

Rosansky S . Multiple cholesterol emboli syndrome. South Med J. 1982; 75(6):677-80. DOI: 10.1097/00007611-198206000-00011. View

Schwartz M, McDonald G . Cholesterol embolization syndrome. Occurrence after intravenous streptokinase therapy for myocardial infarction. JAMA. 1987; 258(14):1934-5. DOI: 10.1001/jama.258.14.1934. View

Coppere B, Granade G, Claudel J, Kruszynski G, Porte J, Gayral M . [Cholesterol crystal embolization after intravenous thrombolysis by anistreplase for suspected myocardial infarction]. Presse Med. 1992; 21(42):2061. View

10.

Rieben F, Waldherr R, Oster P, Schettler G . [Acute renal failure due to diffuse cholesterol crystal embolisation during streptokinase treatment (author's transl)]. Dtsch Med Wochenschr. 1979; 104(41):1447-9. DOI: 10.1055/s-0028-1129119. View

11.

Karalis D, Kaulback K, ROSS Jr J, Uricchio F, Chandrasekaran K . Spontaneous arterial embolization after thrombolytic therapy for acute myocardial infarction: the role of transesophageal echocardiography. Cathet Cardiovasc Diagn. 1994; 31(3):199-201. DOI: 10.1002/ccd.1810310307. View

12.

Beutler J, Sulzer M, van Stralen R . Cholesterol embolism after intravenous anisoylated plasminogen streptokinase activator complex (APSAC). Neth J Med. 1991; 39(5-6):373-4. View

13.

Hendel R, Cuenoud H, Giansiracusa D, Alpert J . Multiple cholesterol emboli syndrome. Bowel infarction after retrograde angiography. Arch Intern Med. 1989; 149(10):2371-4. View

14.

Lie J . Cholesterol atheromatous embolism. The great masquerader revisited. Pathol Annu. 1992; 27 Pt 2:17-50. View

15.

Bucher A, Roald B . [Cholesterol embolization after intravenous streptokinase therapy in acute myocardial infarction]. Tidsskr Nor Laegeforen. 1993; 113(15):1844-5. View

16.

Mendia R, dAloya G, Cavaliere G, Palmeri M, Sparacio F, SORGATO G . Does thrombolysis produce cholesterol embolisation?. Lancet. 1992; 339(8792):562. DOI: 10.1016/0140-6736(92)90391-f. View

17.

Oster P, Rieben F, Waldherr R, Schettler G . Blood clotting and cholesterol crystal embolization. JAMA. 1979; 242(19):2070-1. View

18.

Cosserat J, Bletry O, Frances C, Wechsler B, Piette J, Kieffer E . [Multiple cholesterol embolism mimicking periarteritis nodosa]. Presse Med. 1992; 21(12):557-64. View

19.

Turnbull R, Hayashi A, McLean D . Multiple spontaneous intestinal perforations from atheroembolism after thrombolytic therapy: a case report. Can J Surg. 1994; 37(4):325-8. View

20.

Zaytsev P, Miller K, Pellettiere E . Cutaneous cholesterol emboli with infarction clinically mimicking heparin necrosis--a case report. Angiology. 1986; 37(6):471-6. DOI: 10.1177/000331978603700608. View