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.

• Authors: J Bösiger, F Demarmels Biasiutti
• Journal: Hamostaseologie (Hamostaseologie) Vol. 23 Issue 3 Pg. 131-4 (Aug 2003) ISSN: 0720-9355 [Print] Germany
• PMID: 12923583 (Publication Type: Case Reports, Journal Article)

Chemical References

• Anticoagulants
• Heparin, Low-Molecular-Weight
• Phenprocoumon

Topics

• Aged
• Anticoagulants (therapeutic use)
• Antiphospholipid Syndrome (blood, diagnostic imaging)
• Blood Coagulation Tests
• Heparin, Low-Molecular-Weight (therapeutic use)
• Humans
• Male
• Phenprocoumon (therapeutic use)
• Pulmonary Embolism (blood, diagnostic imaging, drug therapy)
• Recurrence
• Thrombosis (blood, chemically induced, diagnostic imaging)
• Tomography, X-Ray Computed