title: Combined thrombophilic risk factors and essential thrombocythemia in patient with recurrent venous thromboembolic episodes-thirty-three-year follow-up.
abstract: We present the case of a 64 year-old female patient, with a clearly positive family history of venous thromboembolism (VTE), multiple VTE episodes (massive pulmonary embolism, ovarian venous plexus thrombosis, deep venous thrombosis with submassive pulmonary embolism and second deep venous thrombosis) and myocardial infarction. Laboratory tests revealed the resistance to the activated protein C, elevated FVIII and PAI-1. The patient was found to be a heterozygous carrier of FV Leiden, MTHFR C677T and PAI-1 4G/5G mutations. She was diagnosed with essential thrombocythemia at the age of 60. The thirty-three-year follow-up of our patient and detection of recurrent thrombotic episodes in the light of multiple coagulation defects with proved acquired risk factors, contributes to the risk stratification in the group of patients with very high risk. In case of our patient, we stress inadequacy of widely-accepted standard prevention measures. In our opinion, patients with very high risk require additional mechanic and specific medicament methods of VTE prevention.
authors.affiliation: Institute of Cardiovascular Diseases, Clinical Centre of Serbia, Pasterova 2, Belgrade, Serbia and Montenegro.
authors.forename: Nebojsa
authors.initials: N
authors.lastname: Antonijevic
authors.forename: Milica
authors.initials: M
authors.lastname: Stanojevic
authors.forename: Rajko
authors.initials: R
authors.lastname: Milosevic
authors.forename: Valentina
authors.initials: V
authors.lastname: Djordjevic
authors.forename: Milena
authors.initials: M
authors.lastname: Jaukovic
authors.forename: Vlada
authors.initials: V
authors.lastname: Vukcevic
authors.forename: Mirjana
authors.initials: M
authors.lastname: Kovac
authors.forename: Danijela
authors.initials: D
authors.lastname: Mikovic
authors.forename: Dragica
authors.initials: D
authors.lastname: Radojkovic
authors.forename: Zorana
authors.initials: Z
authors.lastname: Vasiljevic
mesh_terms: D000328:Adult; D005192:Family Health; D005260:Female; D005500:Follow-Up Studies; D020022:Genetic Predisposition to Disease; D006801:Humans; D008875:Middle Aged; D017410:Practice Guidelines as Topic; D011247:Pregnancy; D011655:Pulmonary Embolism / Q000209:etiology*; D012008:Recurrence; D012307:Risk Factors; D013920:Thrombocythemia, Essential / Q000175:diagnosis / Q000209:etiology*; D019851:Thrombophilia / Q000150:complications* / Q000175:diagnosis / Q000235:genetics*; D020246:Venous Thrombosis / Q000209:etiology*