Cancer History, Antiphospholipid Syndrome, and Lupus Anticoagulant: A Perfect Storm for Thrombosis

Cancer and antiphospholipid syndrome (APS) independently increase thrombotic risk, and their coexistence can create a particularly hazardous prothrombotic state. This case report aims to highlight the complex challenges in managing concurrent thrombotic and hemorrhagic events in patients with a history of cancer and APS. The combination of these conditions presents a rare and difficult clinical scenario, requiring careful consideration in anticoagulation management. By presenting this case, we seek to emphasize the persistent thrombotic risk in cancer survivors and the importance of considering APS in patients with unexplained thrombotic events. This case report presents a 51-year-old male with a history of duodenal cancer in remission who experienced multiple severe thrombotic events, including an acute ischemic stroke, intracranial hemorrhages following treatment, and a pulmonary embolism. APS was diagnosed based on these events and positive laboratory findings. Management involved a delicate balance between thrombotic and hemorrhagic risks, with anticoagulation initially withheld due to intracranial hemorrhages, then cautiously initiated following the pulmonary embolism. The patient gradually improved, regaining functional independence with mild residual weakness three months post-discharge.