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Deep Vein Thrombosis in A Post-Coronary Artery Bypass Grafting Patient: Successful Conservative Management
S H Sarker1, A K Miraj, M A Hossain
1Dr Md Sanaul Hoque Sarker, MS Phase A Student, Department of Cardiovascular and Thoracic Surgery, Bangabandhu Sheikh Mujib Medical University (BSMMU), Dhaka, Bangladesh.
Insights
Deep vein thrombosis (DVT) is a rare post-coronary artery bypass grafting complication. Early diagnosis and combined anticoagulation with rivaroxaban and heparin led to rapid recovery in a 50-year-old diabetic patient.
Area of Science:
- Cardiology
- Vascular Medicine
- Hematology
Background:
- Deep vein thrombosis (DVT) involves blood clot formation in deep veins, often asymptomatic.
- Post-coronary artery bypass grafting (CABG) DVT is particularly rare in Asian populations.
- DVT symptoms can mimic musculoskeletal disorders, delaying diagnosis.
Observation:
- A 50-year-old diabetic male post-CABG presented with left leg swelling, fever, and calf pain.
- Clinical signs included absent pedal pulse, positive Homan sign, and a Wells score of 7.
- Duplex study confirmed popliteal deep vein thrombosis with recanalization.
Findings:
- The patient received meticulous treatment including bed rest, limb elevation, heparinization, and oral rivaroxaban.
- Rapid recovery was observed following the combined therapeutic approach.
- Anemia of chronic disease due to hemorrhoids was a co-existing condition.
Implications:
- Post-CABG patients benefit from prophylactic anticoagulation (enoxaparin or heparin) for 3-5 days.
- Prompt diagnosis of DVT is crucial for reducing patient morbidity.
- Combined rivaroxaban and heparin therapy shows significant clinical value for post-CABG DVT.
Abstract:
Deep vein thrombosis is an alarming medical emergency. Deep vein thrombosis or deep venous thrombosis (DVT) is the formation of a blood clot (thrombus) within a deep vein predominantly in the legs. Post-Coronary Artery Bypass Grafting deep vein thrombosis is a very rare medical condition relatively in Asian. Approximately 80% of deep vein thrombosis (DVTs) is clinically asymptomatic, 20% of those that actually demonstrate signs and symptoms can be easily confused with symptoms of other commonly presenting musculoskeletal disorders. Proper medical management can reduce patient's morbidity and further burden. A 50 years old diabetic Post-Coronary Artery Bypass Grafting gentleman had been suffering for left leg swelling, high grade fever and calf muscle pain for 5 days. He had absent Arteria Dorsalis Paedis pulse on left foot, Positive Homan sign and Wells score is 7. His left leg was hugely swelled. He had normal leg hair distribution. Duplex study of Left Leg-Deep Vein Thrombosis in left lower limb (Popliteal segment) with sign of recanalization. He is also a patient of anemia of chronic disease due to hemorrhoid. Several investigations have done to find the cause of his chronic anemia. His treatment was meticulous with complete bed rest, elevation of left lower limb, heparinization, oralrivaroxaban. He had rapid recovery following treatment. Post-Coronary Artery Bypass Grafting patient should be given post-operative enoxaparin (Low molecular weight Heparin) or Heparin for 3-5 days. Early diagnosis of the disease condition reduces morbidity. Combined treatment with Rivaroxaban and Heparin is of great clinical value and outcome in a case of Post-Coronary Artery Bypass Grafting Deep Vein Thrombosis patient.
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