Case Report: A potential cardiovascular safety signal during batroxobin therapy for sudden sensorineural hearing loss: a three-case series of acute myocardial infarction

Background Batroxobin, a defibrinogenating agent used as an adjunctive therapy for sudden sensorineural hearing loss (SSNHL), has an incompletely characterized cardiovascular safety profile. Cases We report three male patients with SSNHL who developed acute myocardial infarction (AMI) after batroxobin therapy. All three showed a precipitous fibrinogen decline (nadir: 0.48–0.75 g/L). AMI was diagnosed approximately 24–48 h after the final batroxobin dose. In Case 3, transient chest symptoms began on the day of the final dose and preceded the diagnosis of AMI the following day. Coronary angiography revealed varying degrees of underlying coronary abnormalities in all cases. One patient died of cardiogenic shock; the other two recovered after percutaneous coronary intervention. Conclusion In this case series, AMI occurred within 24–48 h after the final batroxobin administration in the context of marked fibrinogen reduction and underlying coronary abnormalities. These observations suggest a temporal association and raise a potential cardiovascular safety signal. Careful fibrinogen monitoring and individualized cardiovascular assessment may be considered in clinically appropriate patients.