Carpintieri Sabrina, Uyar Elias, Anand Christian, Buryk Yaroslav
Internal Medicine, Ross University School of Medicine, Miami, USA.
Internal Medicine, St. George's University School of Medicine, Brooklyn, USA.
Cureus. 2024 Dec 27;16(12):e76481. doi: 10.7759/cureus.76481. eCollection 2024 Dec.
Cancer and antiphospholipid syndrome (APS) independently increase thrombotic risk, and their coexistence can create a particularly hazardous prothrombotic state. This case report aims to highlight the complex challenges in managing concurrent thrombotic and hemorrhagic events in patients with a history of cancer and APS. The combination of these conditions presents a rare and difficult clinical scenario, requiring careful consideration in anticoagulation management. By presenting this case, we seek to emphasize the persistent thrombotic risk in cancer survivors and the importance of considering APS in patients with unexplained thrombotic events. This case report presents a 51-year-old male with a history of duodenal cancer in remission who experienced multiple severe thrombotic events, including an acute ischemic stroke, intracranial hemorrhages following treatment, and a pulmonary embolism. APS was diagnosed based on these events and positive laboratory findings. Management involved a delicate balance between thrombotic and hemorrhagic risks, with anticoagulation initially withheld due to intracranial hemorrhages, then cautiously initiated following the pulmonary embolism. The patient gradually improved, regaining functional independence with mild residual weakness three months post-discharge.
癌症和抗磷脂综合征（APS）各自都会增加血栓形成风险，二者并存会导致特别危险的血栓前状态。本病例报告旨在突出在管理有癌症病史和APS的患者并发血栓形成和出血事件时面临的复杂挑战。这些病症的组合呈现出一种罕见且棘手的临床情况，在抗凝管理中需要仔细考量。通过呈现此病例，我们旨在强调癌症幸存者中持续存在的血栓形成风险，以及在有不明原因血栓形成事件的患者中考虑APS的重要性。本病例报告介绍了一名51岁男性，有十二指肠癌病史且处于缓解期，他经历了多次严重血栓形成事件，包括急性缺血性中风、治疗后颅内出血以及肺栓塞。基于这些事件和阳性实验室检查结果诊断为APS。管理涉及血栓形成和出血风险之间的微妙平衡，因颅内出血最初停用抗凝治疗，在肺栓塞后谨慎启动抗凝治疗。患者逐渐好转，出院三个月后恢复功能独立，仅遗留轻度残余无力。
