Das Subhraleena, Karachiwala Hatim, Cherian Sujith V, Garcha Amarinder S, Jasti Sushama, Gajra Ajeet
Department of Internal Medicine, SUNY Upstate Medical University, Syracuse, New York, USA.
Blood Coagul Fibrinolysis. 2011 Dec;22(8):746-8. doi: 10.1097/MBC.0b013e32834aa7d7.
Mechanical valve thrombosis is a rare condition in an adequately anticoagulated patient in the absence of underlying thrombophilia. We report a case of a 76-year-old male with mechanical prosthetic mitral valve thrombosis as the presenting feature of polycythemia vera. The patient was treated with thrombolysis at the time of acute presentation and subsequently maintained on low molecular weight heparin, low-dose aspirin, phlebotomy and hydroxyurea. Hemoglobin, leucocytosis and platelet count were controlled for almost 4 years after which the patient suffered a second, fatal episode in the setting of therapeutic anti-Xa level. This case report highlights the thrombotic risks associated with polycythemia vera. The proposed mechanisms of hypercoagulability in polycythemia vera are reviewed. To the best of our knowledge, mechanical valve thromboses as the presenting feature of polycythemia vera has not been reported previously.
在没有潜在血栓形成倾向且抗凝充分的患者中，机械瓣膜血栓形成是一种罕见的情况。我们报告一例76岁男性患者，以机械性人工二尖瓣血栓形成为真性红细胞增多症的首发表现。该患者在急性发作时接受了溶栓治疗，随后持续使用低分子量肝素、小剂量阿司匹林、放血疗法和羟基脲治疗。血红蛋白、白细胞增多和血小板计数得到控制近4年，之后患者在治疗性抗Xa水平的情况下发生了第二次致命事件。本病例报告强调了与真性红细胞增多症相关的血栓形成风险。对真性红细胞增多症中高凝状态的拟议机制进行了综述。据我们所知，此前尚未有以真性红细胞增多症首发表现的机械瓣膜血栓形成的报道。
