Successive bleeding and thrombotic complications in a patient with afibrinogenemia: A case report

Chevalier, Y.; Dargaud, Yesim; Argaud, Laurent; Ninet, J.; Jouanneau, Emmanuel; Négrier, Claude

doi:10.1016/j.thromres.2011.03.012

Cited by 15 publications

(12 citation statements)

References 20 publications

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“…Managing IFD patients with thrombosis is challenging as they may be at risk of life-threatening hemorrhage [8] or require hemostatic support following surgery, trauma, or childbirth [9,10]. In such situations, clinicians face the difficult task of providing sufficient hemostasis while minimizing the risk of thromboembolism.…”

Section: Introductionmentioning

confidence: 99%

Thrombosis in Inherited Fibrinogen Disorders

Korte¹,

Poon

Iorio

et al. 2017

Transfus Med Hemother

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Although inherited fibrinogen disorders (IFD) are primarily considered to be bleeding disorders, they are associated with a higher thrombotic complication risk than defects in other clotting factors. Managing IFD patients with thrombosis is challenging as anticoagulant treatment may exacerbate the underlying bleeding risk which can be life-threatening. Due to the low prevalence of IFD, there is little information on pathophysiology or optimal treatment of thrombosis in these patients. We searched the literature for cases of thrombosis among IFD patients and identified a total of 128 patient reports. In approximately half of the cases, thromboses were spontaneous, while in the others trauma, surgery, and parturition contributed to the risk. The true mechanism(s) of thrombosis in IFD patients remain to be elucidated. A variety of anticoagulant treatments have been used in the treatment or prevention of thrombosis, sometimes with concurrent fibrinogen replacement therapy. There is no definite evidence that fibrinogen supplementation increases the risk of thrombosis, and it may potentially be effective in the treatment and prevention of both thrombosis and hemorrhage in IFD patients.

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Section: Introductionmentioning

confidence: 99%

Thrombosis in Inherited Fibrinogen Disorders

Korte¹,

Poon

Iorio

et al. 2017

Transfus Med Hemother

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“…[6] These complications can occur in the presence of concomitant risk factors such as a co-inherited thrombophilic risk factor or after replacement therapy. [7] However, in many patients, no known risk factors are present. Several hypotheses have been put forward to explain this predisposition to thrombosis.…”

Section: Discussionmentioning

confidence: 99%

“…Though there are several reports of both arterial and venous thrombosis in afibrinogenemia,[78] only a few cases have been reported where these patients developed MI. [2] With recurrent MI, this is the first case we are reporting.…”

Section: Discussionmentioning

confidence: 99%

Recurrent myocardial infarction in a case of congenital Afibrinogenemia

et al. 2014

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Afibrinogenemia is a rare autosomal recessive bleeding disorder with an estimated prevalence of 1:1,000,000. Usual presentation of this disorder is spontaneous bleeding, bleeding after minor trauma and excessive bleeding during interventional procedures. Paradoxically, few patients with afibrinogenemia may also suffer from severe thromboembolic complications. The management of these patients is particularly challenging because they are not only at risk of thrombosis but also of bleeding. We are presenting a case of 33-year-old male patient of congenital afibrinogenemia who had two episodes myocardial infarction in a span of two years. The patient was managed conservatively with antiplatelet therapy and thrombolytic therapy was not given due to high risk for bleeding.

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“…Also, because of the precarious balance of the process of hemostasis, thrombolytics and anti-thrombotic treatments could not be used. The use of these treatments classically contraindicated in fibrinogen deficient patients has nevertheless been described in cases of thrombotic complications, often in parallel with fibrinogen infusion [3-5,10]. …”

Section: Discussionmentioning

confidence: 99%

“…Although uncommon, some cases of venous and arterial thrombotic events associated with fibrinogen deficiency have been reported in the literature [1-9]. The mechanism of this apparently paradoxical thrombotic tendency, which has long remained problematic, has now been partially clarified [10]. …”

Section: Introductionmentioning

confidence: 99%

Acute myocardial infarction in a patient with hypofibrinogenemia: a case report

et al. 2011

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IntroductionCongenital fibrinogen deficiency is a rare coagulation disorder usually responsible for hemorrhagic diathesis. However, it can be associated with thrombosis and there have been limited reports of arterial thrombotic complications in these patients.Case presentationA 42-year-old Tunisian man with congenital hypofibrinogenemia and no cardiovascular risk factors presented with new onset prolonged angina pectoris. An electrocardiogram showed features of inferior acute myocardial infarction. His troponin levels had reached 17 ng/L. Laboratory findings confirmed hypofibrinogenemia and ruled out thrombophilia. Echocardiography was not useful in providing diagnostic elements but did show preserved left ventricular function. Coronary angiography was not performed and our patient did not receive any anticoagulant treatment due to the major risk of bleeding. Magnetic resonance imaging confirmed myocardial necrosis. Our patient was managed with aspirin, a beta-blocker, an angiotensin-converting enzyme inhibitor and statin medication. The treatment was well tolerated and no ischemic recurrence was detected.ConclusionAlthough coronary thrombosis is a rare event in patients with fibrinogen deficiency, this condition is of major interest in view of the difficulties observed in managing these patients.

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Successive bleeding and thrombotic complications in a patient with afibrinogenemia: A case report

Cited by 15 publications

References 20 publications

Thrombosis in Inherited Fibrinogen Disorders

Thrombosis in Inherited Fibrinogen Disorders

Recurrent myocardial infarction in a case of congenital Afibrinogenemia

Acute myocardial infarction in a patient with hypofibrinogenemia: a case report

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