Massive subfascial hematoma after alteplase therapy for acute myocardial infarction

The authors report a case of a patient who received alteplase for acute myo cardial infarction and developed spontaneous subfascial hematoma without an y evidence of direct trauma. Subfascial hematoma remains a rare and self-li mited complication of thrombolytic therapy. The development of cutaneous ec chymosis associated with a sudden fall in hemoglobin after the administrati on of alteplase should strongly suggest the possibility of diffuse subfasci al hematoma. Physicians should be aware of the possible association between the use of alteplase and the development of subfascial hemorrhage.