Challenging anticoagulation therapy for multiple primary malignant tumors combined with thrombosis:A case report and review of literature

作     者：Jia-Xin Chen Ling-Ling Xu Jing-Ping Cheng Xun-Hua Xu 

作者机构：Department of GerontologyChina Resources and Wisco General HospitalWuhan University of Science and TechnologyWuhan 430080Hubei ProvinceChina Medical CollegeWuhan University of Science and TechnologyWuhan 430065Hubei ProvinceChina Department of GerontologyChina Resources and Wisco General HospitalWuhan 430080Hubei ProvinceChina Department of RadiologyChina Resources and Wisco General HospitalWuhan 430080Hubei ProvinceChina 

出 版 物：《World Journal of Clinical Cases》 (世界临床病例杂志)

年 卷 期：2024年第12卷第9期

页      面：1704-1711页

核心收录：

学科分类：1002[医学-临床医学] 100214[医学-肿瘤学] 10[医学] 

主　　题：Venous thromboembolism Cancer-associated thrombosis Anticoagulation therapy iliac vein compression syndrome COVID-19 Thrombocytopenia Case report 

摘      要：BACKGROUND Venous thromboembolism significantly contributes to patient deterioration and mortality.Management of its etiology and anticoagulation treatment is intricate,necessitating a comprehensive consideration of various factors,including the bleeding risk,dosage,specific anticoagulant medications,and duration of therapy.Herein,a case of lower extremity thrombosis with multiple primary malignant tumors and high risk of bleeding was reviewed to summarize the shortcomings of treatment and prudent anticoagulation experience.CASE SUMMARY An 83-year-old female patient was admitted to the hospital due to a 2-wk history of left lower extremity edema that had worsened over 2 d.Considering her medical history and relevant post-admission investigations,it was determined that the development of left lower extremity venous thrombosis and pulmonary embolism in this case could be attributed to a combination of factors,including multiple primary malignant tumors,iliac venous compression syndrome,previous novel coronavirus infection,and inadequate treatment for prior thrombotic events.However,the selection of appropriate anticoagulant medications,determination of optimal drug dosages,and establishment of an appropriate duration of anticoagulation therapy were important because of concurrent thrombocytopenia,decreased quantitative fibrinogen levels,and renal insufficiency.CONCLUSION Anticoagulant prophylaxis should be promptly initiated in cases of high-risk thrombosis.Individualized anticoagulation therapy is required for complex thrombosis.