Medical Management of a Large Aortic Thrombus in a Young Woman With Essential Thrombocythemia

Fang, Ming; Agha, Samina; Lockridge, Leslie; Cleary, Joseph P.; Mazur, Eric Michael

doi:10.4065/76.4.427

Cited by 12 publications

(9 citation statements)

References 20 publications

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“…This is in accordance with reports in other patients not suffering from IBD. 19,26,27,28 Whether thrombus resolution was due to anticoagulant and platelet inhibitor therapy or due to spontaneous fibrinolysis cannot be determined.…”

Section: Discussionmentioning

confidence: 99%

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Aortic Mural Thrombi in Patients With Inflammatory Bowel Disease

Novacek¹,

Haumer²,

Schima³

et al. 2004

Inflammatory Bowel Diseases

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Thromboembolic events are a known complication in inflammatory bowel disease (IBD). We report on 2 young women with IBD and aortic mural thrombi as a source of arterioarterial embolization to the lower limbs resulting in significant morbidity. The first case was a 36-year-old woman with severe ulcerative colitis who presented with signs of microembolism into two toes of her right foot. A thrombus in the otherwise normal infrarenal aorta with occlusion of the inferior mesenteric artery was revealed by computed tomography (CT) and intrarterial angiography. The digital ischemia resolved without sequelae. The second case was a 41-year-old woman with Crohn's disease complicated by fistulas. She developed acute ischemia of her right leg. Arteriography and CT revealed infrapopliteal embolic occlusions and a thrombus in the distal otherwise normal abdominal aorta and the left iliac artery. A primarily successful thrombectomy had to be repeated 5 times because of reocclusion. Eventually the leg was exarticulated at the knee. In both patients no further thromboembolic event occurred during follow-up of 4 1/2 years and 5 1/2 years, respectively, and aortic thrombi had resolved at follow-up CT scans. Extensive work up for hypercoagulability was negative in both patients. We consider IBD as the most likely trigger for arterioarterial embolization in the absence of thrombophilia in both patients. Finally we give an overview of the literature of similar cases with aortic mural thrombi in IBD patients.

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Section: Discussionmentioning

confidence: 99%

“…In a few of the reported cases risk factors for thrombosis, like postoperative status, acute pancreatitis, and documented thrombophilia such as hyperhomocysteinemia, homozygous factor V mutation, protein C and S deficiency, and essential thrombocythemia, have been described. 15–19…”

mentioning

confidence: 99%

Aortic Mural Thrombi in Patients With Inflammatory Bowel Disease

Novacek¹,

Haumer²,

Schima³

et al. 2004

Inflammatory Bowel Diseases

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“…Fang et al reported complete resolution of an intra-aortic thrombus, confirmed by CT scan, in an ET patient three weeks after starting aspirin and hydroxyurea [5]. Additionally, Lorelli and Shepard reported resolution of abdominal pain in an elderly patient with ET-related thrombosis of the aorta, splenic infarction, and portal vein thrombosis treated with anegralide and systemic anticoagulation with warfarin [3].…”

Section: Discussionmentioning

confidence: 99%

Essential Thrombocythemia Complicated by Occlusive Thrombosis of the Abdominal Aorta

Geringer

Fenderson

Osswald

2019

Case Reports in Hematology

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Introduction. Essential thrombocythemia (ET) is a myeloproliferative neoplasm of excessive platelet production complicated by thrombohemorrhagic events. Thrombosis typically occurs in small to medium vessels; thrombosis of large vessels is rare. Case Presentation. A 75-year-old woman with ET complicated by bilateral retinal vein occlusion was evaluated for fatigue, early satiety, and unintentional weight loss. Her hypertension was well controlled, and her chronic lower extremity claudication from peripheral artery disease was stable. She reported adherence to aspirin 81 mg and hydroxyurea 1000 mg daily, and her platelets (375 × 109/L) were at goal. Bone marrow biopsy was consistent with ET without progression to myelofibrosis or leukemia. CT abdomen demonstrated complete occlusion of the infrarenal aorta, extending into the common iliac arteries, with reconstitution of flow distally via collaterals. The addition of clopidogrel, for platelet inhibition, and cilostazol, for claudication, caused symptom improvement without further thrombosis or bleeding. Discussion. There are few published reports of ET complicated by aortic thrombosis. To our knowledge, this is the first report of aortic thrombosis occurring in an ET patient with normal platelet count on antiplatelet and cytoreductive therapies. There is limited evidence to guide treatment, but medical management with triple antiplatelet therapy may be effective in selected patients.

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“…Therefore, it is logical to treat patients with aspirin which is a cyclooxygenase (COX) inhibitor. Aspirin disrupts thromboxan A2 production by inhibiting COX-1 of the arachidonic acid cascade, and it exhibits antiplatelet action [14]. In particular, secondary aggregation, most of which result in the formation of large thrombi, such as an aortic thrombosis, is prevented.…”

Section: Discussionmentioning

confidence: 99%

Aortic thrombus in a patient with myeloproliferative thrombocytosis, successfully treated by pharmaceutical therapy: a case report

et al. 2010

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IntroductionThrombosis in myeloproliferative thrombocytosis occurs usually in the microvessels and medium-sized arteries and veins and only rarely in the aorta. Aortic thrombosis is usually treated with thrombectomy. Reported here is a rare case that was treated pharmacologically.Case presentationA 60-year-old Japanese woman presented with numbness of both lower extremities. Her platelet count was 1787 × 103/μl. Through bone marrow examination, we diagnosed her condition as myelodysplastic and/or myeloproliferative disorder-unclassifiable. Abdominal ultrasonography and computed tomographic scan revealed aortic thrombosis. Her platelet count was controlled with hydroxyurea and ranimustine. Aspirin and ticlopidine improved the numbness in both lower limbs on the second day. Aortic thrombosis was not observed in a computed tomographic scan on the seventh day.ConclusionFor aortic thrombosis, surgical management is usually adopted, but pharmacological management is also an option because of its immediate curative effects.

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Medical Management of a Large Aortic Thrombus in a Young Woman With Essential Thrombocythemia

Cited by 12 publications

References 20 publications

Aortic Mural Thrombi in Patients With Inflammatory Bowel Disease

Aortic Mural Thrombi in Patients With Inflammatory Bowel Disease

Essential Thrombocythemia Complicated by Occlusive Thrombosis of the Abdominal Aorta

Aortic thrombus in a patient with myeloproliferative thrombocytosis, successfully treated by pharmaceutical therapy: a case report

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