Highly thrombogenic phenotype and impaired wound healing in a patient with congenital dysfibrinogenemia: case report

Essentials•Congenital fibrinogen disorders are associated with both bleeding and thrombotic phenotypes.•Lipoprotein a is a thrombogenic and atherogenic molecule, inhibiting the fibrinolytic pathway.•Dysfibrinogenemia can affect wound healing.•Continuous fibrinogen replacement therapy showed healing capacity, despite high lipoprotein a levels.AbstractBackgroundCongenital fibrinogen disorders are classified based on both fibrinogen levels and the clinical phenotype. For dysfibrinogenemia, normal fibrinogen levels are typical.Key Clinical QuestionWe highlight the importance of comprehensive thrombotic risk assessment, including lipoprotein a (Lp[a]) and hypertriglyceridemia in association with severe thrombosis and poor wound healing in dysfibrinogenemia.Clinical ApproachWe report the case of a 42-year-old male patient with a rare congenital thrombotic-related dysfibrinogenemia (fibrinogen Naples) and multiple thrombotic episodes throughout his life and an unhealing ankle wound. Despite all thrombotic episodes and surgery, the patient had undetectable D-dimer, suggestive of fibrinolytic defect, further supported by over 4-fold elevated Lp(a) levels. The last arterial thrombosis was preoperatively managed by plasma exchange, antithrombotics, and thereafter continued fibrinogen replacement therapy, under which the chronic wound has healed.ConclusionThe combination of thrombogenesis, abnormal fibrinogen, and high Lp(a) levels is a clinical and research topic deserving more attention.