u-62840 and Gastrointestinal-Hemorrhage

Treprostinil, a potent vasodilator, is the treatment of choice for severe pulmonary arterial hypertension (PAH) during pregnancy. Its inhibition of platelet aggregation increases the risk of hemorrhage. In addition, anticoagulation therapy is widely used in pregnancy with PAH due to the hypercoagulable state. However, very little is known about the complications of anticoagulants' use in pregnancy with PAH.. A 27-year-old pregnant woman was admitted to the hospital at 32weeks with progressive dyspnea.. The pregnant was diagnosed with ventricular septal defect 12 years prior to presentation. Combining clinical manifestation with results of right heart catheterization (RHC) and echocardiography, it was consistent with severe World Health Organization (WHO) group I PAH.. Supportive treatment included supplemental oxygen, intravenous treprostinil, sildenafil and prophylactic anticoagulation.. Gastrointestinal bleeding is occurred in our patient when dalteparin were used in conjunction with treprostinil. Her care was further complicated refractory to usual conservative measures before delivery.. This case report illustrates the complexities that arise when prostacyclin therapies are combined with necessary anticoagulation in patients with PAH during pregnancy. More intention should play to the complications of anticoagulant in pregnancy with PAH during treprostinil therapy.

Topics: Adult; Anticoagulants; Antihypertensive Agents; Cardiovascular Agents; Dalteparin; Epoprostenol; Female; Gastrointestinal Hemorrhage; Humans; Hypertension, Pulmonary; Pregnancy; Pregnancy Complications, Cardiovascular; Sildenafil Citrate; Vasodilator Agents

Medical treatment of pulmonary arterial hypertension (PAH) is increasingly common. Prostacyclins were introduced in the early 90s, and treprostinil is one of the most frequently used drugs of this class today, owing to its long half-life and to the possibility to administer the molecule through several routes. Treprostinil is considered a safe drug and is associated with a significant improvement of exercise capacity, especially in patients with idiopathic PAH (iPAH). Systemic sclerosis-associated PAH (sc-PAH) correlates to a worse prognosis compared with that of iPAH. Despite these considerations, safety data on treprostinil are still limited and mainly derived from randomised controlled trials and retrospective studies with relatively small and heterogeneous cohorts of patients with PAH. We report the occurrence of a severe intra-abdominal bleeding during treprostinil infusion in a patient with sc-PAH.

Topics: Adult; Angiography; Antihypertensive Agents; Combined Modality Therapy; Epoprostenol; Familial Primary Pulmonary Hypertension; Gastrointestinal Hemorrhage; Gastroscopy; Humans; Hypertension, Pulmonary; Male; Sigmoidoscopy; Tomography, X-Ray Computed