Concurrent pulmonary thrombosis with systemic embolism: a case report

Abstract

Based on different mechanisms of blood coagulation, coexistence of venous thromboembolism and arterial thrombosis in a single individual is extremely rare in clinical practice. Both antiplatelet and anticoagulation therapy should be adopted for patients with arteriovenous embolism. Balancing the risk of ischemia and hemorrhage is especially challenging in these patients in order to achieve an optimal clinical benefit. We report on a 55-year-old female with acute pulmonary embolism (PE), subsequently diagnosed as having acute myocardial infarction (AMI) and a cerebral infarction. Examinations had been carried out, excluding potential arteriovenous shunts, cancer, antiphospholipid syndrome and other common hypercoagulable states. A combination of an anticoagulant drug (rivaroxaban, an Xa inhibitor) and an antiplatelet agent (clopidogrel, an ADP receptor inhibitor) was prescribed with a β-blocker and atorvastatin. The embolus was gradually shrunk during the next 10 months, and then it turned back into expanding. During the 16 months' follow-up, an aneurysm of left ventricular apex was found through an echocardiogram and an angiotensin-converting enzyme inhibitor was administered. We conclude that combined anticoagulation and antiplatelet therapy significantly relieved the symptoms and improved the prognosis in patients suffering from arteriovenous embolism without any major clinical bleeding events.

Leriche syndrome in a patient with acute pulmonary embolism and acute myocardial infarction: a case report and review of literature

“…After thrombus dissolved, we switched to rivaroxaban for anticoagulation while reserving dual antiplatelet for confirmed acute myocardial infarction and Leriche syndrome. Not recognized by current guidelines mostly due to rare occurrences of concomitant APE and AMI, our anticoagulation and dual antiplatelet treatment regimen were indeed supported by individual clinical cases [25][26][27]. Luckily, our patient responded well to the treatment.…”