title: Thrombosis of the internal jugular vein after tympanoplasty caused by interaction of oral contraceptives and hereditary hypofibrinolysis.
abstract: This case report describes a case of venous thrombosis in a young woman who had undergone tympanoplasty due to chronic otitis media. Other than that she was healthy. According to the anamnesis she stopped taking oral contraceptive pills (OCP) a month before the surgery. She did not receive thromboprophylaxis before the surgery because it was estimated that there was a low risk for a thromboembolic incident. Several hours after the surgery she was still not responding properly to external stimulus and there was no verbal contact. An urgent computed tomography (CT) scan of head and neck revealed thrombosis of the left internal jugular vein. She was admitted to the Intensive Care Unit (ICU) and heparin therapy started. After a few days she was fully recovered. Later it was confirmed that the patient had an inherited fibrinolysis disorder caused by plasminogen activator inhibitor 1 (PAI-1) gene polymorphism. Our opinion is that the unexpected thrombotic incident was a result of interaction of multiple factors, including the venous stasis at the surgery site, decreased fibrinolysis ability, and the prothrombotic effect of OCP.
authors.affiliation: Department of Anaesthesiology, Reanimation and Intensive Care Unit, Clinical Hospital Centre Osijek, Croatia.
authors.forename: Dubravka
authors.initials: D
authors.lastname: Ivić
authors.forename: Ivana
authors.initials: I
authors.lastname: Harsanji Drenjancević
authors.forename: Josip
authors.initials: J
authors.lastname: Ivić
authors.forename: Kristina
authors.initials: K
authors.lastname: Kujavec Sljivac
authors.forename: Domagoj
authors.initials: D
authors.lastname: Drenjancević
mesh_terms: D025861:Blood Coagulation Disorders, Inherited / Q000150:complications* / Q000235:genetics; D003276:Contraceptives, Oral / Q000009:adverse effects*; D005260:Female; D005342:Fibrinolysis; D006801:Humans; D007601:Jugular Veins; D017395:Plasminogen Activator Inhibitor 1 / Q000097:blood / Q000235:genetics*; D011110:Polymorphism, Genetic; D011183:Postoperative Complications; D012307:Risk Factors; D014433:Tympanoplasty; D020246:Venous Thrombosis / Q000209:etiology*; D055815:Young Adult
chemical_list: D003276:Contraceptives, Oral; D017395:Plasminogen Activator Inhibitor 1