TO LOAD OR NOT TO LOAD: CLOPIDOGREL IN DIFFUSE ALVEOLAR HEMMORRHAGE

TOPIC: Critical Care TYPE: Medical Student/Resident Case Reports INTRODUCTION: Diffuse alveolar hemorrhage (DAH) after percutaneous coronary intervention (PCI) is a rare complication that has been reported in association with antiplatelet medications. After PCI stent placement, dual therapy (DAPT) crucial preventing thrombosis and other ischemic events the first year. However, management of patients DAH post unclear. In handful case reports which clopidogrel was etiology DAH, indefinitely discontinued, switched another agent, or restarted months resolution. We present associated successfully 12 days discontinuation. CASE PRESENTATION: A 73-year-old woman presented for ambulatory left heart catheterization. drug eluting placed, she started on aspirin, loaded clopidogrel. On hospital day 2, developed acute hypoxemic respiratory failure requiring high flow nasal cannula. Computed tomography (CT) chest obtained 6 revealed bilateral diffuse ground glass opacities interlobular thickening centrilobular nodules, consistent DAH. 7, hemoptysis. Her held, prednisone 40 mg daily, her oxygen requirements HFNC decreased. 14 again given loading dose within hours became more hypoxic. Repeat CT shifting infiltrates, improvement lower lobe but worsening consolidations right side, concerning recurrent Clopidogrel once held. 18, maintenance without dose. were slowly weaned, discharged 24 2 liters home oxygen, DISCUSSION: life-threatening disorder most commonly seen granulomatosis polyangiitis, microscopic Goodpasture's syndrome, antiphospholipid antibody infection, pulmonary embolism, mitral stenosis, malignancy. it also rarely Dual required 3-12 following PCI, so holding caused puts at an increased risk potentially lethal cardiac events, such as thrombosis. CONCLUSIONS: This demonstrates can be avoided when dose, should tried before discontinuing DAPT. REFERENCE #1: Kilaru PK, Schweiger MJ, Kozman HA, Weil TR. use. J Invasive Cardiol. 2001;13:535–7. #2: Onuk, Tolga, Ipek, Göktürk, Karatas, Mehmet Baran, Hac, Recep, Çam, Nese. "Diffuse Alveolar Hemorrhage Use." Balkan Journal 33.6 (2016): 719-20. #3: Grondahl B (2016) Pulmonary While Antiplatelet Therapy. Clin Med Rev Rep 3:118. 10.23937/2378-3656/1410118 DISCLOSURES: No relevant relationships by Elyse LaFond, source=Web Response Joseph Mailman, David Narotsky, Alexander Pronko, Madelyn Renzetti,