Lethal pulmonary embolism in a patient with primary antiphospholipid syndrome and a vena caval filter

A 61-year old Hispanic woman with a history of primary antiphospholipid syndrome with pulmonary emboli and who was status post a vena caval filter placement to prevent recurrent pulmonary emboli, presented with acute onset of right upper quadrant abdominal pain. Acute cholecystitis was diagnosed and she underwent a surgically uncomplicated cholecystectomy. The postoperative course was complicated by new, massive pulmonary emboli despite prophylactic treatment with aspirin and low-dose heparin. Patient died en route to surgery for emergency embolectomy. This case suggests that a regimen of low-dose heparin and aspirin therapy in patients with primary antiphospholipid syndrome and a previously placed vena caval filter is not effective in preventing postoperative thromboembolic complications; more aggressive anticoagulation therapy is required.