Key result
Resumption of anticoagulation in a patient with Factor V Leiden and recent deep intracranial hemorrhage from cavernous angiomas was safe, with no recurrent bleeding at one year.
Why the study?
Anticoagulation for venous thromboembolism after a history of hemorrhagic stroke poses a major therapeutic dilemma.
Is it safe and effective to resume anticoagulation in a patient with high-risk thrombophilia and recurrent VTE following a recent deep intracranial hemorrhage?
Case Report (n=1)
Is it safe and effective to resume anticoagulation in a patient with high-risk thrombophilia and recurrent VTE following a recent deep intracranial hemorrhage?
Resumption of anticoagulation may be considered in high-risk thrombophilia patients with recent deep intracranial hemorrhage when IVC filters fail to prevent recurrent VTE.
Does not alter individualized anticoagulation decisions post-hemorrhagic stroke in VTE; leaves open optimal strategy pending prospective data.
Venous thromboembolism (VTE) is a significant issue occurring due to genetic, acquired and circumstantial risk factors. Treatment is according to the clinical situation and judgment for long term anticoagulation based on individual risk. Anticoagulation after a history of a hemorrhagic stroke poses a therapeutic dilemma. We present a case of a 68-year-old male who presented with right-sided chest pain and shortness of breath. Workup included a CT that was positive for multiple right-sided pulmonary emboli (PE). The patient has a past medical history of Factor V Leiden Mutation, recurrent PE, and deep vein thrombosis (DVT). Two months prior he was diagnosed with a 1.3-cm intracranial hemorrhage (ICH) from multiple cavernous angiomas. At that time his warfarin was discontinued and an inferior vena cave (IVC) filter was placed. Facing the recent ICH and now multiple and recurrent PE, it was decided to resume anticoagulation based on ICH location. ICH from a deep source is likely a better characteristic that favors a resumption of anticoagulation. Our case will highlight that IVC filters cannot be solely relied upon in patients that are at high risk for thrombotic events with underlying genetic thrombophilia.
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Ajmeri et al. (2020) conducted a case report in Venous Thromboembolism Post Intracranial Hemorrhage (n=1). Anticoagulation resumption was evaluated. Resumption of anticoagulation in a patient with Factor V Leiden and recent deep intracranial hemorrhage from cavernous angiomas was safe, with no recurrent bleeding at one year.
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