Cancer associated phlegmasia cerulea dolens successfully treated with apixaban

García-Fernández-Bravo, Irene; Demelo‐Rodríguez, Pablo; Ordieres‐Ortega, Lucía; Álvarez-Luque, Arturo; Toro‐Cervera, Jorge del

doi:10.5045/br.2018.53.1.90

Cited by 7 publications

(7 citation statements)

References 9 publications

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“…Most experts recommend treating PCD with thrombolysis, with heparin as the preferred agent, or thrombectomy [6]. One case reported the successful treatment of PCD with apixaban in a patient with contraindications for surgical intervention [7]. Although thrombolysis was contraindicated in our patient due to recent recurrent SDH, her condition was not stable enough for thrombectomy.…”

Section: Discussionmentioning

confidence: 86%

Half-Dose Anticoagulation for Venous Thromboembolism and Phlegmasia Cerulea Dolens in a Patient With Recurrent Subdural Hematoma

Chan¹,

Adhikari²,

Khan³

2021

Cureus

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Anticoagulation for venous thromboembolism (VTE) in patients with recurrent subdural hematoma (SDH) is challenging. It becomes even more challenging when the patient develops phlegmasia cerulea dolens (PCD). We present a 66-year-old female with a recent history of recurrent SDH who received half-dose heparin therapy for VTE and PCD. The patient had improvement of dyspnea and resolution of PCD after two days of treatment. She was discharged with half-dose enoxaparin. At her one-month follow-up, there was no evidence of new SDH or progression of VTE. Half-dose anticoagulation therapy should be considered in patients with recurrent SDH when anticoagulation is inevitable.

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Section: Discussionmentioning

confidence: 86%

Half-Dose Anticoagulation for Venous Thromboembolism and Phlegmasia Cerulea Dolens in a Patient With Recurrent Subdural Hematoma

Chan¹,

Adhikari²,

Khan³

2021

Cureus

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“…Our patient was promptly started on UFH since she was also anticipated to be taken to surgery and possible thrombolysis/thrombectomy. Although not widely studied, the novel oral anticoagulants (NOACs) including apixaban, have been successfully used to treat cancer-related PCD patients with no recurrence of thrombosis at six months [ 14 , 15 ]. While management with NOACs is studied for cancer-related VTE, it might not be appropriate for PCD management acutely, especially post-thrombolysis/thrombectomy given reversibility-related issues with NOACs.…”

Section: Discussionmentioning

confidence: 99%

Right Lower Extremity Phlegmasia Cerulea Dolens Due to Iliotibial Vein Thrombosis With Compartment Syndrome and Circulatory Shock: Case Report and Review

Dah¹,

Ogbu²,

Ngwudike³

et al. 2022

Cureus

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Phlegmasia cerulea dolens (PCD) is a rare and life-threatening complication of extensive deep vein thrombosis (DVT) characterized by severe pain, swelling, and cyanosis of the affected limb. It results from total or near-total occlusion of the deep and superficial veins of a limb, leading to venous congestion and ischemia. It is associated with 40% mortality, more commonly affecting the left lower extremity, with up to 50% of patients requiring limb amputations. PCD complicated by compartment syndrome (CS) with shock and multiorgan failure is very rare. We report the case of a 55-year-old female who presented with sudden onset, severe right lower extremity pain and swelling with associated limb discoloration, paresthesias, and inability to move the toes of her right foot. On examination, there was cyanosis, pulselessness, and tense right leg and thigh compartments. Doppler ultrasonography revealed DVT of the right external iliac extending to the posterior tibial vein. A diagnosis of PCD with CS was made and the patient was immediately started on anticoagulation with unfractionated heparin and emergent decompressive fasciotomies of the right leg and thigh were performed. Following the fasciotomies, she developed circulatory shock and went into cardiac arrest. Despite successful resuscitation, her hemodynamic instability and multiorgan failure precluded further life-saving interventions including thrombolysis or thrombectomy. Limb amputation was declined given her poor prognosis and she passed away shortly thereafter. This case illustrates the rare occurrence of right lower extremity PCD complicated by CS, circulatory shock, and multiorgan failure, which can sometimes occur despite emergency fasciotomy but can be averted with prompt intervention. These complications often preclude immediate thrombolysis and/or thrombectomy. Its recognition, therefore, warrants timely and more aggressive interventions to prevent limb loss or death.

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“…At 6-month follow up the patient was found to have an incipient post-thrombotic syndrome. 6 Nezami et al described a patient who developed PCD as a result of vertebroplasty-associated cement leakage, and was treated with PT. 7 Another case report presented a patient who developed PCD due to an external compression of the iliofemoral venous axis by a hematoma which resulted from shearing of a sacral screw placed during a spinal fusion surgery.…”

Section: Discussionmentioning

confidence: 99%

“…At 6-month follow up the patient was found to have an incipient post-thrombotic syndrome. 6 Nezami et al. described a patient who developed PCD as a result of vertebroplasty-associated cement leakage, and was treated with PT.…”

Section: Discussionmentioning

confidence: 99%

A comparative analysis of the efficacy and safety of therapeutic interventions in phlegmasia cerulea dolens

2020

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Objective Present an institution’s experience in management of phlegmasia cerulea dolens (PCD) with a review of the literature. Methods Beaumont Health’s electronic record database was queried between July 2009 and November 2019 for inpatients with PCD. A comprehensive chart review was performed to verify the accuracy of the diagnosis and extract relevant parameters. Medians and proportions are reported. Results 22 patients met the criteria for PCD. 59% females. Median age 65 years (interquartile range [IQR] 22). Obesity was present in 45% of patients. 18 patients underwent either a single modality (55.5%) or a multimodality therapeutic approach (44.5%). Limb amputation was required in a third of patients who underwent catheter-directed thrombolysis or percutaneous thrombectomy alone. Death was highest after percutaneous thrombectomy alone (66%) followed by pharmacomechanical catheter-directed thrombolysis alone (50%). Conclusion Percutaneous interventions have become the mainstay in management of PCD as demonstrated in this large retrospective analysis and supported by literature review.

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Cancer associated phlegmasia cerulea dolens successfully treated with apixaban

Cited by 7 publications

References 9 publications

Half-Dose Anticoagulation for Venous Thromboembolism and Phlegmasia Cerulea Dolens in a Patient With Recurrent Subdural Hematoma

Half-Dose Anticoagulation for Venous Thromboembolism and Phlegmasia Cerulea Dolens in a Patient With Recurrent Subdural Hematoma

Right Lower Extremity Phlegmasia Cerulea Dolens Due to Iliotibial Vein Thrombosis With Compartment Syndrome and Circulatory Shock: Case Report and Review

A comparative analysis of the efficacy and safety of therapeutic interventions in phlegmasia cerulea dolens

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