title: A case report of PVOD patient combined with pulmonary embolism: Anticoagulation or not?
abstract: BACKGROUND
  Pulmonary veno-occlusive disease (PVOD) is a rare form of pulmonary arterial hypertension (PAH). Oral anticoagulation is confined to patients with idiopathic PAH (IPAH), but no oral anticoagulation has been recommended for PVOD, because occult pulmonary hemorrhage was a common finding in PVOD.
  
  
  METHODS
  We report a case of PVOD, who was misdiagnosed as IPAH for 5 years with worsening dyspnea and two episodes of pulmonary embolism (PE).
  
  
  METHODS
  He was confirmed as PVOD combined with PE by biopsy of the explanted lung specimen.
  
  
  METHODS
  He took oral anticoagulation, warfarin, to treat his first-time PE in July 2010, and his disease was kept stable for about 4 years, until he discontinued the anticoagulation therapy by himself sometime in 2014. Later on, a life-threatening PE recurred in January 2015, so he resumed the anticoagulation therapy.
  
  
  RESULTS
  Fortunately, the bilateral sequential lung transplantation that was performed in July 2015 in time saved his life. He has been living well without dyspnea and the echocardiography showed the normalizations of the once increased pulmonary arterial pressure and the once enlarged right ventricle of his heart. In addition, to the best of my knowledge, he was the first PVOD patient receiving lung transplantation in China.
  
  
  CONCLUSIONS
  We recommend that PVOD patients combined with PE should be treated with anticoagulation therapy indefinitely to prevent the recurrence of life-threatening PE until they get a chance for lung transplantation.
authors.affiliation: Respiratory Department Pathology Department Cardiothoracic Surgery, People's Hospital of Zhongshan City, Zhongshan City Medical Intern, Sun Yat-Sen University, China.
authors.forename: Xiaoling
authors.initials: X
authors.lastname: Yuan
authors.forename: Xianghe
authors.initials: X
authors.lastname: Hou
authors.forename: Weihong
authors.initials: W
authors.lastname: Guo
authors.forename: Haiming
authors.initials: H
authors.lastname: Jiang
authors.forename: Junmeng
authors.initials: J
authors.lastname: Zheng
authors.forename: Stuti
authors.initials: S
authors.lastname: Paudyal
authors.forename: Yanhua
authors.initials: Y
authors.lastname: Lyu
mesh_terms: D000368:Aged; D000925:Anticoagulants / Q000627:therapeutic use*; D006801:Humans; D008297:Male; D011655:Pulmonary Embolism / Q000209:etiology* / Q000517:prevention & control; D011668:Pulmonary Veno-Occlusive Disease / Q000150:complications* / Q000175:diagnosis / Q000188:drug therapy; D014859:Warfarin / Q000627:therapeutic use*
chemical_list: D000925:Anticoagulants; D014859:Warfarin