Lethal pulmonary embolism in a patient with primary antiphospholipid syndrome and a vena caval filter.
A 61-year old Hispanic woman with a history of primary antiphospholipid syndrome with pulmonary emboli and who was status post a vena caval filter placement to prevent recurrent pulmonary emboli, presented with acute onset of right upper quadrant abdominal pain. Acute cholecystitis was diagnosed and she underwent a surgically uncomplicated cholecystectomy. The postoperative course was complicated by new, massive pulmonary emboli despite prophylactic treatment with aspirin and low-dose heparin. Patient died en route to surgery for emergency embolectomy. This case suggests that a regimen of low-dose heparin and aspirin therapy in patients with primary antiphospholipid syndrome and a previously placed vena caval filter is not effective in preventing postoperative thromboembolic complications; more aggressive anticoagulation therapy is required.
Lee
H C
HC
Department of Internal Medicine, Creighton University School of Medicine, Omaha, Neb.
Laya
M B
MB
D016736:Antiphospholipid Syndrome / Q000150:complications*; D001241:Aspirin / Q000627:therapeutic use; D002763:Cholecystectomy / Q000009:adverse effects; D017809:Fatal Outcome; D005260:Female; D006493:Heparin / Q000627:therapeutic use; D006801:Humans; D008875:Middle Aged; D011655:Pulmonary Embolism / Q000209:etiology* / Q000517:prevention & control; D016306:Vena Cava Filters
D006493:Heparin; D001241:Aspirin