Document Detail


Deep vein and intracardiac thrombosis during the post-partum period in Behçet's disease.
MedLine Citation:
PMID:  20217284     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
A 22-year-old woman presented on the 10th post-partum day with deep vein thrombosis involving the right ilio-femoral and popliteal veins. This thrombosis was refractory to conventional anticoagulation and subsequently over a period of 6 weeks progressed to involve inferior vena cava and right ventricle. A diagnosis of Behçet's disease was made on the clinical grounds of fever, night sweats, and recurrent oral ulcers. In view of refractory thrombosis, anticoagulation with lepirudin was commenced followed by thrombolysis with streptokinase. After thrombolysis, anticoagulation was switched to fondaparinux. Intracardiac thrombus, oral ulcers, constitutional symptoms, and inflammatory indices resolved on 20 mg of oral prednisolone. This case highlights that management of thrombosis unresponsive to conventional anticoagulation requires careful consideration of the underlying conditions, the sites of thrombosis, as well as of the available treatment options. Intravenous lepirudin is a valuable therapeutic option when anticoagulation with warfarin or LMWH is not efficacious. Thrombolytic therapy may be used to treat intracardiac thrombi more rapidly, and possibly more efficiently, than surgery. The addition of corticosteroids or other immunosuppressive drugs is necessary in order to achieve a full resolution of thrombosis.
Authors:
Prashant Hiwarkar; Roberto Stasi; George Sutherland; Muriel Shannon
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Publication Detail:
Type:  Case Reports; Journal Article     Date:  2010-03-10
Journal Detail:
Title:  International journal of hematology     Volume:  91     ISSN:  1865-3774     ISO Abbreviation:  Int. J. Hematol.     Publication Date:  2010 May 
Date Detail:
Created Date:  2010-05-10     Completed Date:  2010-08-13     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  9111627     Medline TA:  Int J Hematol     Country:  United States    
Other Details:
Languages:  eng     Pagination:  679-86     Citation Subset:  IM    
Affiliation:
Department of Haematology, St. George's Hospital, Tooting, London. drhprashant@doctors.net.uk
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MeSH Terms
Descriptor/Qualifier:
Anticoagulants / therapeutic use*
Behcet Syndrome / complications*
Female
Fibrinolytic Agents / therapeutic use
Heart Ventricles
Hirudins
Humans
Iliac Vein
Polysaccharides / therapeutic use
Popliteal Vein
Postpartum Period
Pregnancy
Pregnancy Complications, Hematologic*
Recombinant Proteins / therapeutic use
Streptokinase / therapeutic use
Vena Cava, Inferior
Venous Thrombosis / complications*,  drug therapy*
Young Adult
Chemical
Reg. No./Substance:
0/Anticoagulants; 0/Fibrinolytic Agents; 0/Hirudins; 0/Polysaccharides; 0/Recombinant Proteins; 0/fondaparinux; 0/lepirudin; EC 3.4.-/Streptokinase

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