Okada Akihiro, Kawauchi Takeshi, Terada Yukinori, Hashimoto Kenji
Department of Neurosurgery, Osaka Red Cross Hospital, Osaka, Japan.
Case Rep Neurol. 2025 Jul 14;17(1):107-112. doi: 10.1159/000546461. eCollection 2025 Jan-Dec.
High levels of lipoprotein (a) [Lp (a)] have gained attention as a risk factor for venous thrombosis. Venous thrombosis during pregnancy in women without thrombophilic predisposition is attributed to pregnancy itself. Herein, we report a case of high Lp (a) levels manifesting as recurrent deep vein thrombosis (DVT) and cerebral venous sinus thrombosis (CVST) in different pregnancies.
A 29-year-old Nepalese woman developed DVT during her first pregnancy. Examination revealed no thrombophilic predisposition. The thrombus resolved with oral anticoagulant medication, which was discontinued after 3 months. During the second pregnancy, prophylactic subcutaneous heparin injections were initiated to prevent venous embolism. Following several days of non-administration of heparin, she experienced left occipital pain, and magnetic resonance venogram showed left CVST. Oral anticoagulants were initiated, and her headache resolved within a few days. Additional blood tests showed abnormally high levels of Lp (a) at 113 mg/dL. Six months later, the CVST was partially recanalized.
If venous thrombosis develops during pregnancy in patients without thrombophilic predisposition, Lp (a) levels should be monitored, and long-term anticoagulant medication may be desirable in those with high Lp (a) levels to prevent recurrence of venous thrombosis.
高水平的脂蛋白（a）[Lp（a）]作为静脉血栓形成的危险因素已受到关注。无血栓形成倾向的女性在孕期发生静脉血栓形成归因于妊娠本身。在此，我们报告一例在不同孕期中Lp（a）水平升高表现为复发性深静脉血栓形成（DVT）和脑静脉窦血栓形成（CVST）的病例。
一名29岁的尼泊尔女性在首次妊娠期间发生DVT。检查未发现血栓形成倾向。血栓通过口服抗凝药物得以溶解，3个月后停药。在第二次妊娠期间，开始预防性皮下注射肝素以预防静脉栓塞。在停止使用肝素几天后，她出现左枕部疼痛，磁共振静脉造影显示左CVST。开始口服抗凝药物治疗，她的头痛在数天内缓解。进一步的血液检查显示Lp（a）水平异常升高，达113mg/dL。6个月后，CVST部分再通。
对于无血栓形成倾向的患者，如果在孕期发生静脉血栓形成，应监测Lp（a）水平，对于Lp（a）水平高的患者，可能需要长期抗凝药物治疗以预防静脉血栓形成复发。
