title: Anticoagulant-resistant thrombophilia in a patient with polycythemia vera:  a case report.
abstract: Mechanical valve thrombosis is a rare condition in an adequately anticoagulated patient in the absence of underlying thrombophilia. We report a case of a 76-year-old male with mechanical prosthetic mitral valve thrombosis as the presenting feature of polycythemia vera. The patient was treated with thrombolysis at the time of acute presentation and subsequently maintained on low molecular weight heparin, low-dose aspirin, phlebotomy and hydroxyurea. Hemoglobin, leucocytosis and platelet count were controlled for almost 4 years after which the patient suffered a second, fatal episode in the setting of therapeutic anti-Xa level. This case report highlights the thrombotic risks associated with polycythemia vera. The proposed mechanisms of hypercoagulability in polycythemia vera are reviewed. To the best of our knowledge, mechanical valve thromboses as the presenting feature of polycythemia vera has not been reported previously.
authors: Department of Internal Medicine, SUNY Upstate Medical University, Syracuse, New York, USA. dass@upstate.edu
authors: Subhraleena
authors: S
authors: Das
authors: Hatim
authors: H
authors: Karachiwala
authors: Sujith V
authors: SV
authors: Cherian
authors: Amarinder S
authors: AS
authors: Garcha
authors: Sushama
authors: S
authors: Jasti
authors: Ajeet
authors: A
authors: Gajra
mesh_terms: D000368:Aged; D000925:Anticoagulants / Q000008:administration & dosage* / Q000627:therapeutic use; D001241:Aspirin / Q000008:administration & dosage / Q000627:therapeutic use; D015951:Factor Xa / Q000378:metabolism; D065427:Factor Xa Inhibitors; D017809:Fatal Outcome; D006495:Heparin, Low-Molecular-Weight / Q000008:administration & dosage / Q000627:therapeutic use; D006801:Humans; D006918:Hydroxyurea / Q000008:administration & dosage / Q000627:therapeutic use; D008297:Male; D061185:Mechanical Thrombolysis; D018962:Phlebotomy; D010975:Platelet Aggregation Inhibitors / Q000008:administration & dosage / Q000627:therapeutic use; D010976:Platelet Count; D011087:Polycythemia Vera / Q000097:blood* / Q000150:complications / Q000188:drug therapy; D019851:Thrombophilia / Q000097:blood* / Q000150:complications / Q000188:drug therapy; D013927:Thrombosis / Q000097:blood* / Q000150:complications / Q000188:drug therapy; D014481:United States
chemical_list: D000925:Anticoagulants; D065427:Factor Xa Inhibitors; D006495:Heparin, Low-Molecular-Weight; D010975:Platelet Aggregation Inhibitors; D015951:Factor Xa; D001241:Aspirin; D006918:Hydroxyurea