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Recurrent thrombosis despite anticoagulation in a man with monocytosis. Case 8.

Abstract
Recurrent thromboembolism despite oral anticoagulation is primarily suspicious of overt or occult neoplasia. We report on a man (age: 67 years) who presented with severe thrombophilia which was only controlled when the patient was set on a combined anticoagulation with low molecular weight heparin in supratherapeutic dosage and phenprocoumon with a target INR of 2.0. Despite repeated evaluation over about two years, a malignant tumour could never be demonstrated. However, the patient suffered in addition to a protein S deficiency from an antiphosphospholipid syndrome and a chronic myelomonocytic leukaemia. We postulate that the accepted strong thrombogenicity of antiphosphospholipid syndrome was further increased by protein S deficiency and a possibly procoagulatory effect of the abnormal monocytes explaining the severe thrombophilia resistant to standard therapeutic anticoagulation with a vitamin K antagonist and usual therapeutic doses of low molecular weight heparin, respectively.
AuthorsJ Bösiger, F Demarmels Biasiutti
JournalHämostaseologie (Hamostaseologie) Vol. 23 Issue 3 Pg. 131-4 (Aug 2003) ISSN: 0720-9355 [Print] Germany
PMID12923583 (Publication Type: Case Reports, Journal Article)
Chemical References
  • Anticoagulants
  • Heparin, Low-Molecular-Weight
  • Phenprocoumon
Topics
  • Aged
  • Anticoagulants (therapeutic use)
  • Antiphospholipid Syndrome (blood, radiography)
  • Blood Coagulation Tests
  • Heparin, Low-Molecular-Weight (therapeutic use)
  • Humans
  • Male
  • Phenprocoumon (therapeutic use)
  • Pulmonary Embolism (blood, drug therapy, radiography)
  • Recurrence
  • Thrombosis (blood, chemically induced, radiography)
  • Tomography, X-Ray Computed

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