Recurrent thrombosis despite anticoagulation in a man with monocytosis. Case 8.
Recurrent thromboembolism despite oral anticoagulation is primarily suspicious of overt or occult neoplasia. We report on a man (age: 67 years) who presented with severe thrombophilia which was only controlled when the patient was set on a combined anticoagulation with low molecular weight heparin in supratherapeutic dosage and phenprocoumon with a target INR of 2.0. Despite repeated evaluation over about two years, a malignant tumour could never be demonstrated. However, the patient suffered in addition to a protein S deficiency from an antiphosphospholipid syndrome and a chronic myelomonocytic leukaemia. We postulate that the accepted strong thrombogenicity of antiphosphospholipid syndrome was further increased by protein S deficiency and a possibly procoagulatory effect of the abnormal monocytes explaining the severe thrombophilia resistant to standard therapeutic anticoagulation with a vitamin K antagonist and usual therapeutic doses of low molecular weight heparin, respectively.
Bösiger
J
J
Central Haematology Laboratory, Inselspital, University Hospital, 3010 Bern, Switzerland.
Demarmels Biasiutti
F
F
D000368:Aged; D000925:Anticoagulants / Q000627:therapeutic use*; D016736:Antiphospholipid Syndrome / Q000097:blood / Q000000981:diagnostic imaging; D001780:Blood Coagulation Tests; D006495:Heparin, Low-Molecular-Weight / Q000627:therapeutic use; D006801:Humans; D008297:Male; D010644:Phenprocoumon / Q000627:therapeutic use; D011655:Pulmonary Embolism / Q000097:blood / Q000000981:diagnostic imaging* / Q000188:drug therapy; D012008:Recurrence; D013927:Thrombosis / Q000097:blood / Q000139:chemically induced* / Q000000981:diagnostic imaging; D014057:Tomography, X-Ray Computed
D000925:Anticoagulants; D006495:Heparin, Low-Molecular-Weight; D010644:Phenprocoumon