title: Concurrent pulmonary thrombosis with systemic embolism: a case report.
abstract: Based on different mechanisms of blood coagulation, coexistence of venous thromboembolism and arterial thrombosis in a single individual is extremely rare in clinical practice. Both antiplatelet and anticoagulation therapy should be adopted for patients with arteriovenous embolism. Balancing the risk of ischemia and hemorrhage is especially challenging in these patients in order to achieve an optimal clinical benefit. We report on a 55-year-old female with acute pulmonary embolism (PE), subsequently diagnosed as having acute myocardial infarction (AMI) and a cerebral infarction. Examinations had been carried out, excluding potential arteriovenous shunts, cancer, antiphospholipid syndrome and other common hypercoagulable states. A combination of an anticoagulant drug (rivaroxaban, an Xa inhibitor) and an antiplatelet agent (clopidogrel, an ADP receptor inhibitor) was prescribed with a β-blocker and atorvastatin. The embolus was gradually shrunk during the next 10 months, and then it turned back into expanding. During the 16 months' follow-up, an aneurysm of left ventricular apex was found through an echocardiogram and an angiotensin-converting enzyme inhibitor was administered. We conclude that combined anticoagulation and antiplatelet therapy significantly relieved the symptoms and improved the prognosis in patients suffering from arteriovenous embolism without any major clinical bleeding events.
authors.affiliation: Department of Cardiology, the Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou 310009, China.
authors.forename: Xiao-jie
authors.initials: XJ
authors.lastname: Xie
authors.forename: Ju-bo
authors.initials: JB
authors.lastname: Jiang
authors.forename: Jun
authors.initials: J
authors.lastname: Jiang
authors.forename: Jian-an
authors.initials: JA
authors.lastname: Wang
mesh_terms: D000806:Angiotensin-Converting Enzyme Inhibitors / Q000008:administration & dosage; D000925:Anticoagulants / Q000008:administration & dosage; D002544:Cerebral Infarction / Q000150:complications; D004617:Embolism / Q000150:complications* / Q000188:drug therapy; D005260:Female; D006322:Heart Aneurysm / Q000150:complications / Q000188:drug therapy; D006801:Humans; D008875:Middle Aged; D009203:Myocardial Infarction / Q000150:complications; D010975:Platelet Aggregation Inhibitors / Q000008:administration & dosage; D011655:Pulmonary Embolism / Q000150:complications* / Q000188:drug therapy
chemical_list: D000806:Angiotensin-Converting Enzyme Inhibitors; D000925:Anticoagulants; D010975:Platelet Aggregation Inhibitors
keywords: Acute myocardial infarction (AMI); Cerebral infarction; Pulmonary thrombosis; Ventricular aneurysm