Upper Limb Phlegmasia Cerulea Dolens Secondary to Heparin-induced Thrombocytopenia Leading to Gangrene

Kommalapati, Anuhya; Kallam, Avyakta; Krishnamurthy, Jairam; Tella, Sri Harsha; Koppala, Jahnavi; Tandra, Pavan K.

doi:10.7759/cureus.2853

Cited by 3 publications

(2 citation statements)

References 18 publications

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“…In addition, majority PCD cases involved lower extremity, while upper extremity PCD is extremely rare and account for less than 5% of all PCD cases (4,5). Malignancy, hypercoagulable state, infection, venous stasis, heart diseases and central venous catheter implantation had been identified as common risk factors of DVT and PCD in previous studies, moreover, heparin-induced thrombocytopenia and pacemaker were also reported to induce PCD and venous gangrene (3,(7)(8)(9)(10)(11). The association between venous thromboembolism (VTE) and malignancy has been well studied and described before.…”

Section: Discussionmentioning

confidence: 98%

Upper extremity phlegmasia cerulea dolens complicating supra vena cava embolism in a cervical cancer patient: case report

Ge,

Weng,

Zhao

et al. 2024

Front. Cardiovasc. Med.

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Phlegmasia cerulea dolens (PCD) is a rare yet severe complication of deep vein thrombosis (DVT), characterized by a high amputation rate and mortality. Early diagnosis and treatment are crucial in managing this condition. PCD predominantly affects the lower extremities rather than the upper extremities. We herein present a rare upper extremity PCD case accompanied with supra vena cava and pulmonary embolism in a cervical cancer patient, who presented to our institution with severe pain, edema and irreversible venous gangrene of right upper limb with no response to anticoagulation therapy. Emergency fasciotomy and amputation were performed due to the progressed venous gangrene, however, the patient developed severe infection and coagulation disorders, gastrointestinal bleeding and disseminated intravascular coagulation after the surgery. Despite medical interventions, her family chose to withdraw treatment and the patient died in ICU at the fourth day following emergency surgery.

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Section: Discussionmentioning

confidence: 98%

Upper extremity phlegmasia cerulea dolens complicating supra vena cava embolism in a cervical cancer patient: case report

Ge,

Weng,

Zhao

et al. 2024

Front. Cardiovasc. Med.

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“…Weaver et al [ 7 ] describe three therapeutic measures for the management of PCD: IV heparin, venous thrombectomy, and thrombolytic therapy, and more recently oral anticoagulants like argatroban have been described to be effective under special circumstances by other authors [ 8 ]. Their data suggest that non-gangrenous forms of PCD have a successful response to systemic anticoagulation.…”

Section: Discussionmentioning

confidence: 99%

Phlegmasia Cerulea Dolens: A New Perspective on Management

Gross¹,

Jimenez²,

Ciobanu³

et al. 2021

Cureus

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This is a case of phlegmasia cerulea dolens (PCD) with unexpected but complete resolution of symptoms with short-term administration of heparin products, despite falling into category IIb according to the Rutherford limb ischemia scale, which regularly requires aggressive surgical intervention.We present a case of a 58-year-old Hispanic female with a past medical history of gastritis who arrived at the emergency room (ER) with acute onset severe pain on the left leg associated with discoloration of the leg. The patient was quickly diagnosed with PCD affecting the left lower extremity, which quickly resolved after administration of heparin infusion for one hour, despite the degree of limb ischemia.There is no consensus for the treatment of this condition. The most interesting feature of this case is the prompt resolution of symptoms with short-term administration of anticoagulation with total resolution without the need for thrombolysis or thrombectomy. This may suggest that prompt pharmacologic treatment in patients eligible for anticoagulation may successfully restore venous flow negating the need for further intervention.

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Management of heparin-induced thrombocytopenia: systematic reviews and meta-analyses

et al. 2020

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Heparin-induced thrombocytopenia (HIT) is a prothrombotic adverse drug reaction occurring in <0.1% to 7% of patients receiving heparin products depending on the patient population and type of heparin. Management of HIT is highly dependent on a sequence of tests for which clinicians may or may not have the results when care decisions need to be made. We conducted systematic reviews of the effects of management strategies in persons with acute HIT, subacute HIT A or B, and remote HIT. We searched Medline, EMBASE, and the Cochrane Database through July 2019 for previously published systematic reviews and primary studies. Two investigators independently screened and extracted data and assessed the certainty of the evidence using the Grading of Recommendations Assessment, Development and Evaluation approach. We found primarily noncomparative studies and case series assessing effects of treatments, which led to low to very low certainty evidence. There may be little to no difference in the effects between nonheparin parenteral anticoagulants and direct oral anticoagulants in acute HIT. The benefits of therapeutic-intensity may be greater than prophylactic-intensity anticoagulation. Using inferior vena cava filters or platelet transfusion may result in greater harm than not using these approaches. Evidence for management in special situations, such as for patients undergoing cardiovascular interventions or renal replacement therapy, was also low to very low certainty. Additional research to evaluate nonheparin anticoagulants is urgently needed, and the development of novel treatments that reduce thrombosis without increasing hemorrhage should be a priority.

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Upper Limb Phlegmasia Cerulea Dolens Secondary to Heparin-induced Thrombocytopenia Leading to Gangrene

Cited by 3 publications

References 18 publications

Upper extremity phlegmasia cerulea dolens complicating supra vena cava embolism in a cervical cancer patient: case report

Upper extremity phlegmasia cerulea dolens complicating supra vena cava embolism in a cervical cancer patient: case report

Phlegmasia Cerulea Dolens: A New Perspective on Management

Management of heparin-induced thrombocytopenia: systematic reviews and meta-analyses

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