A woman in her 50s with Factor V Leiden and recent surgery with history of multiple right-sided deep venous thromboses not on anticoagulation due to a prior bleeding complication presented with acute left groin pain and discolouration. Physical exam was concerning for a condition in which a large blood clot blocks the major deep veins of the legs causing painful swelling and a pale appearance. CT imaging revealed a massive occlusive thrombus. Point of care ultrasound was significant for a completely collapsed inferior vena cava. The patient’s presentation progressed, and she subsequently underwent clot removal and was started on Heparin for anticoagulation. She was subtherapeutic on heparin and was started on argatroban. On discharge, she was transitioned to fondaparinux.
Postoll-Downs et al. (Sun,) studied this question.