Ajmeri Aman N, Zaheer Kamran, McCorkle Colin, Amro Ahmed, Mustafa Bisher
Internal Medicine, Marshall University, Joan C. Edwards School of Medicine, Huntington, USA.
Cardiology, Marshall University, Joan C. Edwards School of Medicine, Huntington, USA.
Cureus. 2020 Jan 22;12(1):e6746. doi: 10.7759/cureus.6746.
Venous thromboembolism (VTE) is a significant issue occurring due to genetic, acquired and circumstantial risk factors. Treatment is according to the clinical situation and judgment for long term anticoagulation based on individual risk. Anticoagulation after a history of a hemorrhagic stroke poses a therapeutic dilemma. We present a case of a 68-year-old male who presented with right-sided chest pain and shortness of breath. Workup included a CT that was positive for multiple right-sided pulmonary emboli (PE). The patient has a past medical history of Factor V Leiden Mutation, recurrent PE, and deep vein thrombosis (DVT). Two months prior he was diagnosed with a 1.3-cm intracranial hemorrhage (ICH) from multiple cavernous angiomas. At that time his warfarin was discontinued and an inferior vena cave (IVC) filter was placed. Facing the recent ICH and now multiple and recurrent PE, it was decided to resume anticoagulation based on ICH location. ICH from a deep source is likely a better characteristic that favors a resumption of anticoagulation. Our case will highlight that IVC filters cannot be solely relied upon in patients that are at high risk for thrombotic events with underlying genetic thrombophilia.
静脉血栓栓塞症（VTE）是一个由遗传、后天和环境危险因素导致的重要问题。治疗需根据临床情况，并基于个体风险判断进行长期抗凝。有出血性中风病史的患者进行抗凝治疗存在治疗困境。我们报告一例68岁男性患者，其出现右侧胸痛和呼吸急促症状。检查包括CT，结果显示右侧多发性肺栓塞（PE）呈阳性。该患者既往有因子V莱顿突变、复发性PE和深静脉血栓形成（DVT）病史。两个月前，他被诊断出因多发性海绵状血管瘤导致1.3厘米的颅内出血（ICH）。当时停用了他的华法林，并放置了下腔静脉（IVC）滤器。面对近期的ICH以及现在的多发性和复发性PE，根据ICH的位置决定恢复抗凝治疗。深部来源的ICH可能是更有利于恢复抗凝治疗的特征。我们的病例将强调，对于存在潜在遗传性血栓形成倾向且有血栓事件高风险的患者，不能单纯依赖IVC滤器。
