Key result
UFH followed by apixaban resolves cancer-associated thrombosis and neurological deficits without bleeding in one case.
Case Report (n=1)
No
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Cancer-associated thrombosis can present as multiple brain infarctions even during complete remission of indolent lymphoma, and anticoagulation with heparin followed by apixaban can be safe and effective despite thrombocytopenia.
We report the case of a 76-year-old man with follicular lymphoma who developed cancer-associated thrombosis (CAT) presenting as multiple brain infarctions during complete remission (CR). After the fourth cycle of R-CHOP (rituximab, cyclophosphamide, doxorubicin, vincristine, and prednisolone) and pegfilgrastim, the patient presented with dysarthria and right upper-limb paresis. Brain magnetic resonance imaging demonstrated multiple brain infarctions with a positive three-territory sign, specific for cancer-associated brain infarctions. Laboratory tests revealed leukocytosis and thrombocytopenia. Whole-body computed tomography demonstrated CR without thrombosis. Anticoagulation with unfractionated heparin, followed by apixaban, resulted in neurological improvements. The patient was discharged without bleeding or any neurological sequelae. This case highlights that CAT can occur even in indolent lymphoma during CR and that anticoagulation is effective and safe despite the presence of thrombocytopenia.
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Tokura et al. (2026) conducted a case report in follicular lymphoma (n=1). unfractionated heparin followed by apixaban was evaluated on neurological improvements and complete remission of thrombosis. Unfractionated heparin followed by apixaban treatment resulted in full neurological recovery and complete remission of follicular lymphoma without any bleeding complications in a patient with cancer-associated thrombosis.
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