Lemierre Syndrome: Often Overlooked

Anticoagulation Strategies in the Management of Lemierre Syndrome: A Systematic Review of the Literature

“…Significant neck pain, with or without other constitutional symptoms, was described in every patient with an IJV thrombosis. 16-25,27,28 This lends credence to the notion that LS should be readily included in the differential diagnosis of pharyngitis, tonsillitis, and other infections of the oral cavity. 11 An additional evaluation of the clinical presentation of the patients included in this evaluation revealed the presence of pulmonary implications, specifically rales, wheezing, and dyspnea.…”

“…It is important to note that every case report initially began anticoagulation with an intravenous or subcutaneous medication, such as heparin, enoxaparin, or fondaparinux, though only 2 reports detailed a transition to a direct-acting oral anticoagulant (DOAC) as opposed to an outpatient regimen of enoxaparin or warfarin therapy. [16][17][18][19][20][21][22][23][24][25][26][27][28][29] Although difficult to ascertain definitive treatment regimens from the limited data available, several important distinctions can be gleaned with regard to patient presentation and the duration of anticoagulation therapy. Significant neck pain, with or without other constitutional symptoms, was described in every patient with an IJV thrombosis.…”

“…16 Based on the information and the extrapolation of data from all of the above, it may be plausible to consider 6 to 12 weeks as the ideal anticoagulation window for patients with IJV thrombosis attributed to LS. [16][17][18][19][20][21][22][23][24][25][26][27][28][29] Although not congruent in terms of pathophysiology, treatment guidance can theoretically be applied to LS from the vast amount of clinical data available for the management of venous thromboembolisms (VTEs). 30 The 2016 CHEST guidelines indicated that DOACs should be utilized rather than warfarin for select, clinically stable patients.…”