Blood Res
BR
Blood Research
2287-979X
2288-0011
Korean Society of Hematology; Korean Society of Blood and Marrow Transplantation; Korean Society of Pediatric Hematology-Oncology; Korean Society on Thrombosis and Hemostasis
10.5045/br.2019.54.1.1
Images of Hematology
Recurrent bilateral deep vein thrombosis after cava vein resection in a patient with leiomyosarcoma
Lucia
Ordieres-Ortega
Pablo
Demelo-Rodríguez
Sandra
Piqueras-Ruiz
Jorge
Del-Toro-Cervera
Venous Thromboembolism Unit, Internal Medicine Department, Hospital General Universitario Gregorio Marañón, Madrid, Spain.
Correspondence to Ordieres-Ortega Lucía, M.D., Hospital General Universitario Gregorio Marañón, C/. Doctor Esquerdo, 46, 28007, Madrid, Spain, lucia.oomere@gmail.com
03
2019
21
03
2019
54
1
1
1
14
04
2018
07
05
2018
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2018
© 2019 Korean Society of Hematology
2019
Korean Society of Hematology
This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.
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A 71-year-old patient was diagnosed with retroperitoneal leiomyosarcoma of the inferior vena cava (IVC) (A, B). He underwent IVC resection under the infrarenal arteries. Enoxaparin (40 mg daily) was administered. Five days after surgery, the patient complained of right lower limb (RLL) edema and pain. Doppler ultrasound revealed venous thrombosis of the RLL including the external iliac, superficial femoral, and popliteal veins. Full-dose enoxaparin was initiated (1 mg/kg/12 hr). Five days later, the patient exhibited left lower limb (LLL) edema and pain. New Doppler ultrasound showed distal deep vein thrombosis (DVT). His renal function was normal (creatinine 0.77 mg/dL), and the treatment was switched to tinzaparin (175 UI/kg/24 hr). His progress was favorable, and he was discharged 14 days after the surgery. Nineteen days later, he presented with an LLL volume increase. Computed tomography showed thrombosis progression bilaterally affecting the ilio-femoro-popliteal axis (C). The tinzaparin dose was increased by 20%. Recurrent DVT may have been related to immobilization, recent surgery, and lack of IVC drainage. After 3 months of anticoagulation, his status was favorable without bleeding events. The patient showed incipient signs of bilateral post-thrombotic syndrome. Based on his anatomical predisposition to DVT and presentation severity, long-term oral anticoagulation was considered.