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A 50-year-old woman with bilateral lower limb deep vein thrombosis developed acute chest pain and kidney injury after starting anticoagulation. This case highlights potential complications and diagnostic challenges in patients with venous thromboembolism.

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Area of Science:

  • Internal Medicine
  • Cardiology
  • Hematology

Background:

  • A 50-year-old woman presented with lower limb pain, asthenia, and arthralgia.
  • Medical history included a prior fetal death and recent deep vein thrombosis (DVT).

Purpose of the Study:

  • To investigate the cause of acute chest pain, abdominal pain, and kidney injury in a patient with DVT following anticoagulation initiation.
  • To evaluate for potential complications of anticoagulation therapy and underlying conditions.

Main Methods:

  • Clinical presentation and laboratory findings including hemoglobin, platelet count, C-reactive protein, d-dimer, and creatinine.
  • Diagnostic imaging including compression ultrasonography of lower limbs, contrast-enhanced CT of the chest, abdomen, and pelvis, and cardiac MRI.
  • Cardiac evaluation including electrocardiography and echocardiography, and emergency coronary angiography.

Main Results:

  • Bilateral calf vein thrombosis was diagnosed, and anticoagulation with low-molecular-weight heparin was initiated.
  • Post-anticoagulation, the patient developed dyspnea, chest and abdominal pain, elevated blood pressure, tachycardia, and fingertip necrosis.
  • Laboratory tests revealed worsening kidney function, proteinuria, and elevated troponin levels, with moderately reduced left ventricular ejection fraction.

Conclusions:

  • The patient's presentation suggests a complex clinical scenario possibly involving anticoagulation-related complications or an underlying systemic process.
  • Further investigation is warranted to determine the precise etiology of the multi-organ system involvement and guide management.