Elrefaeei Abdelrahman N, Al-Nahhas Omar F, Al-Nahhas Mohammed F, Jaiganesh Thiagarajan
Emergency Medicine, Tawam Hospital, Al Ain, ARE.
Clinical Sciences, Ajman University, Ajman, ARE.
Cureus. 2025 May 18;17(5):e84319. doi: 10.7759/cureus.84319. eCollection 2025 May.
We present the case of a 40-year-old female with a previous diagnosis of unprovoked deep vein thrombosis (DVT), who had been on long-term warfarin therapy but discontinued it one month before presentation. She arrived at the emergency department following two episodes of transient loss of consciousness at work, raising concerns for a possible cerebrovascular event. Further evaluation revealed evidence of systemic embolization, as she developed acute basilar artery thrombosis and left upper limb ischemia findings consistent with multiple embolic events. Computed tomography angiography (CTA) demonstrated a mural thrombus in the thoracic aorta and occlusion of the left brachial artery. The patient received intravenous recombinant tissue plasminogen activator (rTPA), followed by successful mechanical thrombectomy of the basilar artery. She was managed with systemic anticoagulation and discharged neurologically intact. This case highlights the critical importance of maintaining anticoagulation in high-risk individuals and demonstrates the potentially life-threatening consequences of abrupt discontinuation.
我们报告了一例40岁女性病例，该患者既往诊断为特发性深静脉血栓形成（DVT），一直在接受长期华法林治疗，但在就诊前一个月停药。她在工作中经历了两次短暂意识丧失后到达急诊科，引发了对可能发生脑血管事件的担忧。进一步评估发现了全身栓塞的证据，因为她出现了急性基底动脉血栓形成以及与多次栓塞事件相符的左上肢缺血表现。计算机断层血管造影（CTA）显示胸主动脉有壁内血栓以及左肱动脉闭塞。患者接受了静脉注射重组组织型纤溶酶原激活剂（rTPA），随后成功进行了基底动脉机械取栓术。她接受了全身抗凝治疗，出院时神经功能完好。该病例突出了在高危个体中维持抗凝治疗的至关重要性，并证明了突然停药可能带来的危及生命的后果。
