Postpartum deep vein thrombosis resolved by catheter-directed thrombolysis: A case report

Research output: Contribution to journalArticle

Abstract

Rationale:Postpartum deep vein thrombosis is a unique condition in diagnosis and treatment. Rivaroxaban, a novel oral anticoagulant, is indicated for acute deep vein thrombosis, but limited data have been reported for postpartum women. Catheter-directed thrombolysis is a common procedure for treating acute deep vein thrombosis, but it is rarely used for postpartum patients, especially after more than 3 months.Patient concerns:A 31-year-old Asian woman suffered from progressive erythematous swelling and local heat of the left lower limb after twin delivery.Diagnoses:Venous duplex ultrasound examination showed thrombus formation in the left femoral vein and popliteal vein with reduced compressibility. After standard treatment of novel oral anticoagulant therapy for 4 months, we observed only partial improvement of the symptoms, and the condition deteriorated after her ordinary activities.Interventions:Venography was performed and a large amount of thrombus lining from left femoral vein to left iliac vein was noted with total occluded left common iliac vein. After catheter-directed thrombolysis and balloon dilatation, better flow was regained and her symptoms improved completely after procedure.Outcomes:During a 1-year follow-up without medication, the patient did not complain about leg swelling, exercise aggravation, or any other post-thrombotic symptoms.Lessons:Pregnancy seems to be a transient provoking factor for deep vein thrombosis, but it is sometimes refractory even during the postpartum period.Follow-up imaging studies should be encouraged to confirm the vessel condition, particularly for applying down-titration or discontinuation strategies of medication.Catheter-directed thrombolysis could be considered as an alternative method for postpartum iliofemoral deep vein thrombosis. Postpartum women usually have favorable functional status and lower bleeding risk.Rivaroxaban is a favorable choice for deep vein thrombosis, but its use in postpartum women is still controversial, and evidence of its effectiveness is not available. Thus, endovascular intervention can be a relatively safe therapy, in addition to anticoagulation therapy for premenopausal patients with recurrent deep vein thrombosis.

Original languageEnglish
Article numbere16052
JournalMedicine (United States)
Volume98
Issue number24
DOIs
Publication statusPublished - 2019 Jun 1

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Venous Thrombosis
Postpartum Period
Catheters
Iliac Vein
Femoral Vein
Anticoagulants
Thrombosis
Popliteal Vein
Therapeutics
Phlebography
Dilatation
Lower Extremity
Leg
Hot Temperature
Exercise
Hemorrhage
Pregnancy

All Science Journal Classification (ASJC) codes

  • Medicine(all)

Cite this

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title = "Postpartum deep vein thrombosis resolved by catheter-directed thrombolysis: A case report",
abstract = "Rationale:Postpartum deep vein thrombosis is a unique condition in diagnosis and treatment. Rivaroxaban, a novel oral anticoagulant, is indicated for acute deep vein thrombosis, but limited data have been reported for postpartum women. Catheter-directed thrombolysis is a common procedure for treating acute deep vein thrombosis, but it is rarely used for postpartum patients, especially after more than 3 months.Patient concerns:A 31-year-old Asian woman suffered from progressive erythematous swelling and local heat of the left lower limb after twin delivery.Diagnoses:Venous duplex ultrasound examination showed thrombus formation in the left femoral vein and popliteal vein with reduced compressibility. After standard treatment of novel oral anticoagulant therapy for 4 months, we observed only partial improvement of the symptoms, and the condition deteriorated after her ordinary activities.Interventions:Venography was performed and a large amount of thrombus lining from left femoral vein to left iliac vein was noted with total occluded left common iliac vein. After catheter-directed thrombolysis and balloon dilatation, better flow was regained and her symptoms improved completely after procedure.Outcomes:During a 1-year follow-up without medication, the patient did not complain about leg swelling, exercise aggravation, or any other post-thrombotic symptoms.Lessons:Pregnancy seems to be a transient provoking factor for deep vein thrombosis, but it is sometimes refractory even during the postpartum period.Follow-up imaging studies should be encouraged to confirm the vessel condition, particularly for applying down-titration or discontinuation strategies of medication.Catheter-directed thrombolysis could be considered as an alternative method for postpartum iliofemoral deep vein thrombosis. Postpartum women usually have favorable functional status and lower bleeding risk.Rivaroxaban is a favorable choice for deep vein thrombosis, but its use in postpartum women is still controversial, and evidence of its effectiveness is not available. Thus, endovascular intervention can be a relatively safe therapy, in addition to anticoagulation therapy for premenopausal patients with recurrent deep vein thrombosis.",
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Postpartum deep vein thrombosis resolved by catheter-directed thrombolysis : A case report. / Chen, Po-Wei; Liu, Ping-Yen.

In: Medicine (United States), Vol. 98, No. 24, e16052, 01.06.2019.

Research output: Contribution to journalArticle

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