Management of Postpartum Extensive Venous Thrombosis after Second Pregnancy
<i>Background</i>: Pregnancy induces a physiological prothrombotic state. The highest risk period for venous thromboembolism and pulmonary embolism in pregnant women is during the postpartum period. <i>Materials and Methods</i>: We present the case of a young woman who gave b...
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MDPI AG
2023-04-01
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| Series: | Medicina |
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| Online Access: | https://www.mdpi.com/1648-9144/59/5/871 |
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| author | Andreea Taisia Tiron Anca Filofteia Briceag Liviu Moraru Lavinia Alice Bălăceanu Ion Dina Laura Caravia |
| author_facet | Andreea Taisia Tiron Anca Filofteia Briceag Liviu Moraru Lavinia Alice Bălăceanu Ion Dina Laura Caravia |
| author_sort | Andreea Taisia Tiron |
| collection | DOAJ |
| description | <i>Background</i>: Pregnancy induces a physiological prothrombotic state. The highest risk period for venous thromboembolism and pulmonary embolism in pregnant women is during the postpartum period. <i>Materials and Methods</i>: We present the case of a young woman who gave birth 2 weeks before admission and was transferred to our clinic for edema. She had an increased temperature in her right limb, and a venous Doppler of the limb confirmed thrombosis of the right femoral vein. From the paraclinical examination, we obtained a CBC with leukocytosis, neutrophilia, and thrombocytosis, and a positive D-dimer test. Thrombophilic tests were negative for AT III, lupus anticoagulant negative, and protein S and C, but were positive for heterozygous PAI-1, heterozygous MTHFR A1298C, and EPCR with A1/A2 alleles. After 2 days of UFH with therapeutic APTT, the patient had pain in her left thigh. We performed a venous Doppler, which revealed bilateral femoral and iliac venous thrombosis. During the computed tomography examination, we assessed the venous thrombosis extension on the inferior cava, common iliac, and bilateral common femoral veins. Thrombolysis was initiated with 100 mg of Alteplase given at a rate of 2 mg/h; however, this did not lead to a considerable reduction in the thrombus. Additionally, the treatment with UFH was continued under therapeutic APTT. After 7 days of UFH and triple antibiotic therapy for genital sepsis, the patient had a favorable evolution with remission of venous thrombosis. <i>Results</i>: Alteplase is a thrombolytic agent that is created with recombinant DNA technology, and it was successfully used to treat thrombosis that occurred in the postpartum period. <i>Conclusions</i>: Thrombophilias are associated with a high VTE risk but also with adverse pregnancy outcomes, including recurrent miscarriages and gestational vascular complications. In addition, the postpartum period is associated with a higher VTE risk. A thrombophilic status with heterozygous PAI-1, heterozygous MTHFR A1298C, and EPCR with A1/A2 positive alleles is associated with a high risk of thrombosis and cardiovascular events. Thrombolysis can be successfully used postpartum to treat VTEs. Thrombolysis can be used successfully in VTE developed in the postpartum period. |
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| issn | 1010-660X 1648-9144 |
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| spelling | doaj.art-9655a067b732438e8a6b5e4fdc36e0e62023-11-18T02:21:29ZengMDPI AGMedicina1010-660X1648-91442023-04-0159587110.3390/medicina59050871Management of Postpartum Extensive Venous Thrombosis after Second PregnancyAndreea Taisia Tiron0Anca Filofteia Briceag1Liviu Moraru2Lavinia Alice Bălăceanu3Ion Dina4Laura Caravia5Faculty of Medicine, “Carol Davila” University of Medicine and Pharmacy, 050474 Bucharest, RomaniaDepartment of Cardiology, ”St. John” Emergency Hospital, 13 Vitan Barzesti Street, 042122 Bucharest, RomaniaDepartment of Anatomy, ”George Emil Palade” University of Medicine, Pharmacy, Sciences and Technology, 540142 Targu Mures, RomaniaFaculty of Medicine, “Carol Davila” University of Medicine and Pharmacy, 050474 Bucharest, RomaniaFaculty of Medicine, “Carol Davila” University of Medicine and Pharmacy, 050474 Bucharest, RomaniaDivision of Cellular and Molecular Biology and Histology, Department of Morphological Sciences ”Carol Davila” University of Medicine and Pharmacy, 050474 Bucharest, Romania<i>Background</i>: Pregnancy induces a physiological prothrombotic state. The highest risk period for venous thromboembolism and pulmonary embolism in pregnant women is during the postpartum period. <i>Materials and Methods</i>: We present the case of a young woman who gave birth 2 weeks before admission and was transferred to our clinic for edema. She had an increased temperature in her right limb, and a venous Doppler of the limb confirmed thrombosis of the right femoral vein. From the paraclinical examination, we obtained a CBC with leukocytosis, neutrophilia, and thrombocytosis, and a positive D-dimer test. Thrombophilic tests were negative for AT III, lupus anticoagulant negative, and protein S and C, but were positive for heterozygous PAI-1, heterozygous MTHFR A1298C, and EPCR with A1/A2 alleles. After 2 days of UFH with therapeutic APTT, the patient had pain in her left thigh. We performed a venous Doppler, which revealed bilateral femoral and iliac venous thrombosis. During the computed tomography examination, we assessed the venous thrombosis extension on the inferior cava, common iliac, and bilateral common femoral veins. Thrombolysis was initiated with 100 mg of Alteplase given at a rate of 2 mg/h; however, this did not lead to a considerable reduction in the thrombus. Additionally, the treatment with UFH was continued under therapeutic APTT. After 7 days of UFH and triple antibiotic therapy for genital sepsis, the patient had a favorable evolution with remission of venous thrombosis. <i>Results</i>: Alteplase is a thrombolytic agent that is created with recombinant DNA technology, and it was successfully used to treat thrombosis that occurred in the postpartum period. <i>Conclusions</i>: Thrombophilias are associated with a high VTE risk but also with adverse pregnancy outcomes, including recurrent miscarriages and gestational vascular complications. In addition, the postpartum period is associated with a higher VTE risk. A thrombophilic status with heterozygous PAI-1, heterozygous MTHFR A1298C, and EPCR with A1/A2 positive alleles is associated with a high risk of thrombosis and cardiovascular events. Thrombolysis can be successfully used postpartum to treat VTEs. Thrombolysis can be used successfully in VTE developed in the postpartum period.https://www.mdpi.com/1648-9144/59/5/871postpartumvenous thrombosispregnancymanagement |
| spellingShingle | Andreea Taisia Tiron Anca Filofteia Briceag Liviu Moraru Lavinia Alice Bălăceanu Ion Dina Laura Caravia Management of Postpartum Extensive Venous Thrombosis after Second Pregnancy Medicina postpartum venous thrombosis pregnancy management |
| title | Management of Postpartum Extensive Venous Thrombosis after Second Pregnancy |
| title_full | Management of Postpartum Extensive Venous Thrombosis after Second Pregnancy |
| title_fullStr | Management of Postpartum Extensive Venous Thrombosis after Second Pregnancy |
| title_full_unstemmed | Management of Postpartum Extensive Venous Thrombosis after Second Pregnancy |
| title_short | Management of Postpartum Extensive Venous Thrombosis after Second Pregnancy |
| title_sort | management of postpartum extensive venous thrombosis after second pregnancy |
| topic | postpartum venous thrombosis pregnancy management |
| url | https://www.mdpi.com/1648-9144/59/5/871 |
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