title: [Venous and arterial thromboembolism in a patient with factor V R506Q Leiden mutation and heparin-induced immuno-allergic reaction].
abstract: A forty-six-year old in-patient was treated with heparin for massive pulmonary embolism. During the hospitalization, the clinical evolution was unusual and characterised as follows: a) the extent of pulmonary embolism justified a thrombolysis by streptokinase; b) an acute thrombocytopenia occurred a few days later, preceded by a slower, but significant decrease of platelet count; c) a non-occlusive aortic thrombosis developed, distal to renal arteries, causing distal embolisation, successfully treated by local fibrinolysis. The prompt correction of platelet count after interruption of heparin therapy confirmed the diagnosis, before the detection of antibodies against heparin-PF4 complexes. Heparin was immediately replaced by another direct anticoagulant, recombinant hirudin (lépirudine-Refludan), initially given alone and progressively replaced by an antivitamin K (Sintrom). The occurrence of distal embolism from aortic thrombosis, developed during the critical period, characterizes this syndrome, which appears rare but whose incidence is probably underestimated. A subsequent investigation for risk factors for venous thromboembolism in this patient revealed a heterozygous mutation of the Leiden type factor V in our patient, and also in others family members.
authors.affiliation: Unité de Soins intensifs médicaux, Département de Médecine, CHU Liège.
authors.forename: L
authors.initials: L
authors.lastname: Letawe-Gilis
authors.forename: B
authors.initials: B
authors.lastname: Lambermont
authors.forename: J L
authors.initials: JL
authors.lastname: David
mesh_terms: D000925:Anticoagulants / Q000009:adverse effects* / Q000276:immunology / Q000627:therapeutic use; D005165:Factor V / Q000235:genetics*; D006493:Heparin / Q000009:adverse effects* / Q000276:immunology / Q000627:therapeutic use; D024764:Hirudin Therapy; D006801:Humans; D008297:Male; D008875:Middle Aged; D017354:Point Mutation; D011655:Pulmonary Embolism / Q000150:complications / Q000188:drug therapy* / Q000473:pathology; D012307:Risk Factors; D013921:Thrombocytopenia / Q000139:chemically induced* / Q000276:immunology; D013923:Thromboembolism / Q000150:complications / Q000209:etiology*
chemical_list: D000925:Anticoagulants; C095381:factor V Leiden; D005165:Factor V; D006493:Heparin
vernacular_title: Accidents thrombo-emboliques veineux et artériels chez un patient porteur d'une mutation du facteur V R506Q Leiden et ayant développé une réaction immuno-allergique à l'héparine.