Acta Medica Iranica 2017. 55(6):411-413.

An Uncommon Complication of Streptokinase: Large Spontaneous Iliopsoas Hematoma
Raheleh Aliabadi, Hassan Riahi Beni, Jila Nadjafi, Morteza Hassanzade, Mehrnaz Tabrizi, Mohsen Nasiri, Gandom Sedehi, Ali Pourmojarab


Streptokinase is a fibrinolytic agent that enhances plasmin activation and is used in selected patients with acute ST elevation myocardial infarction (STEMI). Similar to the other thrombolytics, a common side effect is bleeding, especially from venous puncture sites. Here, we present a case of acute anterior wall STEMI complicated by large spontaneous iliopsoas hematoma after streptokinase administration. With conservative management, the course of the disease was uneventful, and the patient was discharged with no symptom and no clinically important sequel.


Streptokinase; ST elevation myocardial infarction; Hematoma; Iliopsoas muscle

Full Text:



O'Gara PT, Kushner FG, Ascheim DD, Casey DE, ChungMK, de Lemos JA, et al. Management of ST-elevation myocardial infarction: a report of the American Collegeof Cardiology Foundation/American Heart AssociationTask Force on Practice Guidelines. ACCF/AHAguideline. Circulation 2013;127:e362-425.

O'Gara PT, Kushner FG, Ascheim DD, Casey DE, ChungMK, de Lemos JA, et al. Management of ST-elevationmyocardial infarction: executive summary: a report of theAmerican College of Cardiology Foundation/American

Heart Association Task Force on Practice Guidelines.ACCF/AHA guideline. Circulation 2013;127:529-55.

Berkowitz SD, Granger CB, Pieper KS, Lee KL, GoreJM, Simoons M, et al. Incidence and predictors ofbleeding after contemporary thrombolytic therapy formyocardial infarction. The Global Utilization ofStreptokinase and Tissue Plasminogen activator forOccluded coronary arteries (GUSTO) I Investigators.Circulation 1997;95:2508-16.

Hochman JS, Tamis JE, Thompson TD, Weaver WD,White HD, Werf F VD, et al. Sex, clinical presentation,and outcome in patients with acute coronary syndromes.Global Use of Strategies to Open Occluded CoronaryArteries in Acute Coronary Syndromes IIb Investigators.N Engl J Med 1999;341:226-32.

The GUSTO investigators. An international randomizedtrial comparing four thrombolytic strategies for acutemyocardial infarction. N Engl J Med 1993;329:673-82.

Holmes DR Jr, Califf RM, Topol EJ. Lessons we havelearned from the GUSTO trial. (1995) Global Utilizationof Streptokinase and Tissue Plasminogen Activator forOccluded Arteries. J Am Coll Cardiol 25:10S-17S.

The GUSTO Angiographic Investigators. The effects oftissue plasminogen activator, streptokinase, or both oncoronary-artery patency, ventricular function, andsurvival after acute myocardial infarction. N Engl J Med1993;329:1615-22.

Uncini A, Tonali PL, Falappa P, Danza FM. Femoralneuropathy from iliac muscle hematoma induced by oralanticoagulation therapy. J Neurol 1981;226:137-141.

Holscher RS, Leyten FSS, Oudenhoven LFIJ, PuylaertJBCM. Percutaneous decompression of an iliopsoashematoma. Abdom Imaging 1997;22:114-6.

Parmer SS, Carpenter JP, Fairman RM, Velazquez OC,Mitchell ME. Femoral neuropathy followingretroperitoneal hemorrhage: case series and review of theliterature. Ann Vasc Surg 2006;20:536-40.

Kaynar M, Pişkin MM, Güven S. İdiyopatikretroperitoneal hematom. Olgu sunumu. Selçuk Ünv TıpDergisi 2010;26:146-7.

Goodfellow J, Fearn CB, Matthews JM. Iliacushaematoma - a common complication of haemophilia.Bone J Surg 1967;49:748-56.

Sasson Z, Mangat I, Peckham KA. Spontaneous iliopsoashematoma in patients with unstable coronary syndromes

receiving intravenous heparin in therapeutic doses. Can JCardiol 1996;12:490-4.

Simeone JF, Robinson F, Rothman SLG, Jaffe CC.Computerised tomographic demonstration of aretroperitoneal haematoma causing femoral neuropthy. JNeurosurg 1977;47:946-8.

Qanadli SD, EI Hajjam , Mignon F, Bruckert F, ChagnonS, Lacombe P. Life-threatening spontaneous psoashaematoma treated by transcatheterarterial embolization.Eur Radiol 1999;9:1231-4.


  • There are currently no refbacks.

Creative Commons Attribution-NonCommercial 3.0

This work is licensed under a Creative Commons Attribution-NonCommercial 3.0 Unported License which allows users to read, copy, distribute and make derivative works for non-commercial purposes from the material, as long as the author of the original work is cited properly.