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Blood Being Tricky: Anticoagulation-Resistant Venous Thromboembolism (VTE)
Raghu Tiperneni1, Adhithya Rajamohan1, Rana Prathap P Padappayil1
1Internal Medicine, Rutgers Health/Monmouth Medical Center, Long Branch, USA.
Cureus
|June 17, 2022
Summary
This case study highlights a rare instance of recurrent venous thromboembolism (VTE) resistant to standard treatments in a 40-year-old male. The patient presented with extensive deep vein thrombosis, posing significant therapeutic challenges.
Area of Science:
- Cardiovascular Medicine
- Hematology
Background:
- Venous thromboembolism (VTE), encompassing deep venous thrombosis (DVT) and pulmonary embolism (PE), is a significant cause of morbidity and mortality.
- Standard treatments include anticoagulation and mechanical thrombectomy, typically yielding straightforward management.
- Recurrent or refractory VTE cases present complex clinical challenges.
Observation:
- A rare case of recurrent VTE in a 40-year-old male is presented.
- The patient exhibited resistance to multiple therapeutic options, including direct oral anticoagulants (DOACs), vitamin K antagonists, heparin, and catheter-directed thrombolysis.
- The presentation involved an occlusive thrombus in the entirety of the right-sided deep venous structures with minimal flow preservation.
Findings:
- This case underscores the existence of VTE presentations refractory to established treatment modalities.
- The extensive nature of the thrombus in a young patient highlights the potential for aggressive VTE disease.
- Diagnostic and therapeutic strategies for complex VTE require careful consideration.
Implications:
- Further research into the mechanisms of VTE resistance is warranted.
- Development of novel therapeutic approaches for refractory VTE is crucial.
- This case emphasizes the need for individualized treatment plans in complex venous thromboembolism management.
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