Stawiarski Kristin M, Patil Gourav, Witt David, Pollack Ari
Section of Cardiovascular Medicine, Yale New Haven Health Bridgeport Hospital, Bridgeport, CT, USA.
Department of Internal Medicine, Griffin Hospital, Derby, CT, USA.
World J Oncol. 2021 Jun;12(2-3):73-76. doi: 10.14740/wjon1384. Epub 2021 May 14.
Multiple myeloma (MM) poses inherent risk of thrombosis that can be amplified by the use of immunomodulator therapy. We present a patient with MM who was being treated with lenalidomide and dexamethasone when he developed progressive dyspnea on exertion consistent with a left lower pulmonary vein thrombosis (PVT) despite use of prophylactic aspirin. The PVT was not initially seen on standard computed tomography angiogram pulmonary embolism protocol but was seen on 192-slice multidetector computed tomography angiogram for assessment of coronary calcifications 8 months later. Subsequent treatment with full dose rivaroxaban resulted in full clot resolution and symptom improvement. PVT has not been previously reported with lenalidomide therapy and may not be a forefront differential diagnosis. In such cases, a multi-modality diagnostic approach may be beneficial. Consideration should be given to escalating venous thromboembolism prophylaxis to full dose anticoagulation during increased prothrombotic windows, such as the time of treatment initiation or dose adjustments, in low bleeding risk patients.
多发性骨髓瘤（MM）存在血栓形成的固有风险，而免疫调节剂治疗可能会加剧这种风险。我们报告了一名MM患者，他在接受来那度胺和地塞米松治疗时，尽管使用了预防性阿司匹林，但仍出现进行性劳力性呼吸困难，与左下肺静脉血栓形成（PVT）相符。最初，标准的计算机断层扫描血管造影肺栓塞方案未发现PVT，但8个月后，在用于评估冠状动脉钙化的192层多排计算机断层扫描血管造影中发现了PVT。随后使用全剂量利伐沙班治疗使血栓完全溶解，症状改善。此前尚未有来那度胺治疗导致PVT的报道，PVT可能不是首要的鉴别诊断。在这种情况下，多模态诊断方法可能有益。对于出血风险较低的患者，在血栓形成风险增加的窗口期，如治疗开始或剂量调整时，应考虑将静脉血栓栓塞预防措施升级为全剂量抗凝。
