Spinal epidural hematoma secondary to tenecteplase for ST-elevation myocardial infarction in the setting of trauma and cervical endplate fracture: Spinal hematoma from tenecteplase for STEMI

Abstract A 78-year-old female presented with an inferior ST-segment elevation myocardial infarction in the setting of a fall resulting in facial trauma causing an unrecognized C6 cervical endplate fracture. Following administration of tenecteplase, she developed a spinal epidural hematoma requiring intubation for airway protection and cessation of antiplatelet therapies. The need to delay coronary intervention in this setting led to a recurrent inferolateral ST-segment elevation myocardial infarction that eventually required coronary bypass grafting. In the first report of a spinal epidural hematoma following tenecteplase for ST-segment elevation myocardial infarction, we emphasize the need for imaging following significant trauma before initiating thrombolysis.