Refractory venous thrombus propagation in the setting of therapeutic anticoagulation.
Refractory venous thrombus propagation in the setting of therapeutic anticoagulation.
复制标题
抗凝治疗中难治性静脉血栓的传播。
DOI：
10.1097/phm.0b013e3182241618
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发表时间：
2011
影响因子：
3
通讯作者：
Rashbaum,Ira
中科院分区：
文献类型：
--
作者：
Traeger,ZahavaTzila;Rizzo,John-Ross;Rashbaum,Ira
一位68岁的绅士，患有心房颤动、高血压和糖尿病，急性缺血性中风累及左小脑后动脉。下肢静脉双工显示右髂总静脉和双侧腘静脉深静脉血栓形成。他开始服用华法林和静脉注射肝素；然而，他出现了肝素诱导的血小板减少症。放置下腔静脉（IVC）过滤器。他随后入院接受急性住院中风康复治疗。他继续使用华法林，他的国际标准化比率保持在治疗范围内。双侧下肢肿胀加重。重复下肢静脉双工显示左下肢血栓从腘静脉到股总静脉和隐静脉的进展。右下肢的血栓由不闭塞发展为闭塞。胸部、腹部和骨盆的计算机断层扫描显示血栓延伸到下腔静脉滤过器上方（图1）。考虑到患者在使用华法林治疗期间血栓不断恶化，他的抗凝剂改为氟肝素。启动fondaparinux一周后，重复计算机断层扫描显示血栓近端延伸至IVC滤过器上方的最小缩回（图2）。患者在病情稳定的情况下出院至亚急性康复机构。
A 68-yr-old gentleman with atrial fibrillation, hypertension, and diabetes mellitus sustained an acute ischemic stroke involving the left posterior cerebellar artery. Lower limb venous duplex revealed deep venous thromboses in the right common iliac vein and bilateral popliteal veins. He was started on warfarin and intravenous heparin; however, he developed heparin-induced thrombocytopenia. An inferior vena cava (IVC) filter was placed. He was subsequently admitted for acute inpatient stroke rehabilitation. He continued warfarin, and his international normalized ratio remained within the therapeutic range. His bilateral lower limb swelling increased. Repeat lower limb venous duplex revealed progression of the left lower limb thrombus from the popliteal to the common femoral and saphenous veins. The thrombus in the right lower limb progressed from being nonocclusive to being occlusive. Computerized tomography of the chest, abdomen, and pelvis revealed thrombotic extension above the IVC filter (Fig. 1). Given the patient’s worsening thromboses while on therapeutic warfarin, his anticoagulation was changed to fond-aparinux. One week after initiating fondaparinux, repeat computed tomography demonstrated minimal retraction of the proximal end of the thrombus that extended above the IVC filter (Fig. 2). The patient was discharged on fondaparinux in stable condition to a subacute rehabilitation facility.