Patients presenting with acute myocardial infarction and syncope may have unrecognized trauma from falls, placing them at high risk for massive bleeding following thrombolytic therapy.
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May warrant trauma screening in AMI with syncope before thrombolysis; case reports leave open systematic validation.
Complete atrioventricular block and syncope sometimes are the presenting signs of acute myocardial infarction. In a presyncopal attempt to assume sitting position, the patient may fall and suffer consequent trauma. Once in hospital, this sequence of events may be overlooked by both the patient and admitting physicians. Moreover, physical examination initially may not be revealing. We report on two such patients who developed massive subcutaneous bleeding following thrombolytic and heparin treatment. We conclude that these patients constitute a specific group with a relatively high risk of trauma and bleeding at the gluteal region following thrombolytic therapy. Special attention must be given to these patients.
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Cohen et al. (1998) studied this question.
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