Compartment Syndrome in Hand Related to Streptokinase: Full Recovery after Fasciotomy

Abstract

Aims: The use of fibrinolytic for the treatment of patients with ST segment elevation myocardial infarction (STEMI) reduces mortality but is associated with an increased risk of bleeding, especially when are performed in combination with invasive procedures. Presentation of Case: A 58-year-old woman transferred due to STEMI was submitted to fibrinolytic therapy (streptokinase: 1,500,000 units). Despite improvement in symptoms and ECG findings, the patient developed sudden pulmonary congestion requiring noninvasive ventilatory support. Despite the risk of bleeding, the medical team who provided initial care decided to perform a radial arterial puncture to collect a blood sample for gas analysis due to clinical instability. When the patient arrived in our Emergency Department, she had an extensive hematoma in the right hand after the radial puncture reducing perfusion and venous return with edema and blisters. The patient was submitted to urgent ventral and dorsal fasciotomy with improvement in distal perfusion and complete recovery of the functional status of the hand is 30 days. Discussion: This kind of compartment syndrome is associated with risk of necrosis and hand amputation. The vascular surgeon was urgently convoked and the approach with rapid surgery, reversal of hemostasis with blood products, and dressing series allowed the functional recovery of the hand without re-occurrence. This risk should be taken into account by the physicians when an invasive procedure is considered hours after the use of a fibrinolytic. In case of a similar complication, an urgent approach with fasciotomy can be associated with great clinical results in 30 days. Conclusion: This case demonstrates serious post-puncture complications of radial artery with a risk of necrosis and hand amputation. This procedure should be avoided after recent administration of fibrinolytic therapy. Fasciotomy performed early allowed full recovery of the hand.