Tenecteplase for ST-elevation myocardial infarction in a patient treated with drotrecogin alfa (activated) for severe sepsis: a case report

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Conclusion
Further research is needed on the prognostic significance of elevated cardiac troponins and ST-elevation as well as their relationship to myocardial infarction in critically ill patients. A guideline is also needed to advise treatment strategies in septic patients who develop STEMI/non-STEMI while being treated with other fibrinolytic agents not approved for myocardial infarction such as DrotAA.

Abbreviations
APC: activated protein C; DrotAA: drotrecogin alfa (activated); ECG: electrocardiogram; EF: ejection fraction; ICU: intensive care unit; INR: international normalized ratio; MAP: mean arterial pressure; PTT: partial thromboplastin time; STEMI: ST-elevation myocardial infarction; TNK: tenecteplase

Consent
Written informed consent was obtained from the patient for publication of this case report and any accompanying images. A copy of the written consent is available for review by the Editor-in-Chief of this journal.

Competing interests
The authors declare that they have no competing interests.

Authors' contributions
LB collected and analyzed all patient data, conducted a literature review and was a major contributor in writing the manuscript. JS collected and analyzed data related to the patient's stay in the intensive care unit. JGP collected, interpreted and analyzed data related to cardiac investigation. RK analyzed all data pertinent to the case, conducted a literature review and was a major contributor in writing the manuscript. All authors read and approved the final manuscript.

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