Diffuse alveolar hemorrhage as a complication of dual antiplatelet therapy for acute coronary syndrome

Diffuse alveolar hemorrhage after percutaneous coronary intervention is a rare complication that has been mostly reported in association with glycoprotein IIb/IIIa inhibitors. We herein report a case of a 64-year-old male who developed a diffuse pulmonary hemorrhage after coronary stent implantation for ST-elevation myocardial infarction. Diagnostic bronchoscopy determined the hemorrhage to be a bland pulmonary hemorrhage, and this pattern suggested that combination therapy with aspirin and ticlopidine was therefore the most likely cause. The combination of aspirin and thienopyridine agents is a routine therapeutic protocol for patients after coronary stent implantation. Therefore, physicians should be aware that this dual antiplatelet therapy might sometimes induce fatal complications. (C) 2011 Elsevier Inc. All rights reserved.