Posters
Presentation Type
Poster
Discipline Track
Patient Care
Abstract Type
Case Report
Abstract
Background: Anti-phospholipid syndrome (APS) is an immune-mediated condition characterized by the presence of antiphospholipid antibodies in the setting of venous and arterial thrombosis and or pregnancy loss [1]. APS can be a primary syndrome or can be associated with connective tissue diseases such as systemic lupus erythematosus. The goal of treatment in patients with APS is to decrease the risk of thromboembolic events and the standard of care is warfarin therapy. We describe a case of a 42-year-old gentleman with a history of APS on anticoagulation with apixaban who presented to the hospital with severe abdominal pain secondary to infrarenal IVC thrombosis. This case highlights the importance of appropriate anticoagulation in patients with APS.
Case Presentation: A 42-year-old man with a past medical history of APS presented to the hospital with a 7-day history of bilateral, dull, non-radiating, generalized abdominal pain. He denied any associated diarrhea, constipation, changes in urination, fever, nausea, or vomiting. Physical examination was notable for tachycardia with HR 110s, BP 150/100 mmHg, and a distended, tender abdomen with visible abdominal varicosities. Labs revealed a WBC 20,000 th/uL, creatinine of 2.0 mg/dL, AST 15 IU/L, ALT 20 IU/L, alkaline phosphatase 101gm/dL, INR of 1.12, and a PTT of 62.2 secs. CT abdomen and pelvis without contrast showed severe narrowing and occlusion of the infrarenal inferior vena cava over a length of 6-7 cm with dilated tortuous varices. Liver US demonstrated normal-appearing flow in hepatic veins and the intrahepatic IVC. The patient was evaluated by surgery however recommendations were made to treat the patient medically with a heparin drip with a bridge to warfarin.
Discussion: Anticoagulation therapy in patients with APS is important as these patients can develop severe, life-threatening thrombotic events. Warfarin therapy is superior to direct oral anticoagulant (doac) therapy in preventing thrombotic events in these patients. Given the episode of thrombosis on doac therapy, our patient will be on lifelong warfarin therapy with an INR goal of 3.5. He has not had a recurrence of thrombotic events.
Academic/Professional Position
Resident
Academic/Professional Position (Other)
PGY2
Mentor/PI Department
Internal Medicine
Recommended Citation
Bartl, Mery; Loftis, Christine E.; Rodriguez-Paez, Josenny; and Dulgheru, Emilia C., "A Whole CLOTTA Pain: A Case of IVC Thrombosis Presenting as Severe Abdominal Pain in a Patient with Anti-Phospholipid Syndrome" (2023). Research Symposium. 68.
https://scholarworks.utrgv.edu/somrs/2022/posters/68
Included in
Hematology Commons, Internal Medicine Commons, Rheumatology Commons
A Whole CLOTTA Pain: A Case of IVC Thrombosis Presenting as Severe Abdominal Pain in a Patient with Anti-Phospholipid Syndrome
Background: Anti-phospholipid syndrome (APS) is an immune-mediated condition characterized by the presence of antiphospholipid antibodies in the setting of venous and arterial thrombosis and or pregnancy loss [1]. APS can be a primary syndrome or can be associated with connective tissue diseases such as systemic lupus erythematosus. The goal of treatment in patients with APS is to decrease the risk of thromboembolic events and the standard of care is warfarin therapy. We describe a case of a 42-year-old gentleman with a history of APS on anticoagulation with apixaban who presented to the hospital with severe abdominal pain secondary to infrarenal IVC thrombosis. This case highlights the importance of appropriate anticoagulation in patients with APS.
Case Presentation: A 42-year-old man with a past medical history of APS presented to the hospital with a 7-day history of bilateral, dull, non-radiating, generalized abdominal pain. He denied any associated diarrhea, constipation, changes in urination, fever, nausea, or vomiting. Physical examination was notable for tachycardia with HR 110s, BP 150/100 mmHg, and a distended, tender abdomen with visible abdominal varicosities. Labs revealed a WBC 20,000 th/uL, creatinine of 2.0 mg/dL, AST 15 IU/L, ALT 20 IU/L, alkaline phosphatase 101gm/dL, INR of 1.12, and a PTT of 62.2 secs. CT abdomen and pelvis without contrast showed severe narrowing and occlusion of the infrarenal inferior vena cava over a length of 6-7 cm with dilated tortuous varices. Liver US demonstrated normal-appearing flow in hepatic veins and the intrahepatic IVC. The patient was evaluated by surgery however recommendations were made to treat the patient medically with a heparin drip with a bridge to warfarin.
Discussion: Anticoagulation therapy in patients with APS is important as these patients can develop severe, life-threatening thrombotic events. Warfarin therapy is superior to direct oral anticoagulant (doac) therapy in preventing thrombotic events in these patients. Given the episode of thrombosis on doac therapy, our patient will be on lifelong warfarin therapy with an INR goal of 3.5. He has not had a recurrence of thrombotic events.