Introduction Congenital hypofibrinogenemia is usually framed as a bleeding disorder, but paradoxical thrombosis is increasingly recognized. The simultaneous occurrence of severe spontaneous intracerebral hemorrhage and unprovoked deep vein thrombosis in a single patient is rarely reported, and much of the published management experience comes from specialized centers with access to fibrinogen concentrate, antigen assays, and genetic testing. We describe such a patient managed in a Middle Eastern center where these resources were not available. Clinical findings A 37-year-old nulliparous Jordanian woman with congenital hypofibrinogenemia, diagnosed at age 17 after refractory bleeding following appendectomy and complicated at age 28 by a spontaneous medullary hemorrhage with full neurological recovery, presented with a three-day history of painful left calf swelling without a provoking factor. Examination showed unilateral calf swelling and tenderness without active bleeding. Diagnoses, interventions, and outcomes Compression Doppler ultrasonography demonstrated an acute occlusive popliteal deep vein thrombosis. Functional fibrinogen by the Clauss method was 0.45 g/L (reference 2.0–4.0 g/L). Fibrinogen antigen, reptilase time, viscoelastic testing, and FGA/FGB/FGG sequencing were unavailable locally. She was managed with subcutaneous enoxaparin 1 mg/kg every 12 hours and cryoprecipitate targeted to maintain a trough functional fibrinogen of at least 1 g/L. Symptoms resolved by hospital day 2. A subsequent bleeding episode was managed with fresh frozen plasma and enoxaparin dose reduction. At six months she remained free of recurrent thrombosis and major bleeding. Conclusion Low fibrinogen does not protect against venous thromboembolism, and concurrent anticoagulation with cryoprecipitate-based replacement is feasible when fibrinogen concentrate is unavailable. Reported per the CARE guideline.
Bawa'neh et al. (Wed,) studied this question.