Vol. 5 (2021): International Journal of Case Reports
Case Reports

Case of recurrent pulmonary thromboembolism due to therapeutic non-compliance

Mihaela Anghele1*, Liliana Dragomir2, Virginia MARINA3
1MD. Mihaela ANGHELE: CLINICAL-MEDICAL Department, «Dunarea de jos» University of Galati, Faculty of Medicine and Pharmacy, Galati, Romania. 2MD. Liliana DRAGOMIR: CLINICAL-MEDICAL Department, «Dunarea de jos» University of Galati, Faculty of Medicine and Pharmacy, Galati, Romania. 3PH.D. Virginia MARINA: MEDICAL Department of Occupational Health, «Dunarea de jos» University of Galati, Faculty of Medicine and Pharmacy, Galati, Romania.

Keywords

  • Pulmonary thromboembolism, recurrent venous thromboembolism, non-compliance, treatment

How to Cite

Mihaela Anghele1*, Liliana Dragomir2, Virginia MARINA3. (2021). Case of recurrent pulmonary thromboembolism due to therapeutic non-compliance. International Journal of Case Reports, 5, 223. https://doi.org/10.28933/ijcr-2021-06-0805

Abstract

Pulmonary embolism occurs when thrombi enter the pulmonary arterial circulation. Most pulmonary embolisms are the result of deep venous thrombosis of the pelvic limbs, chest or pelvis, and, less commonly, the jugular veins or inferior vena cava.

Venous thromboembolism includes deep vein thrombosis and pulmonary embolism. It is the third most common cardiovascular disease, with a total annual incidence of 100-200 per 100 000 population.

INTRODUCTION: Acute pulmonary embolism is the most serious clinical presentation of venous thromboembolism. Overall, pulmonary embolism is a major cause of mortality, morbidity and hospitalization. Mortality in pulmonary embolism depends on haemodynamic impairment, age and co morbidities.

The prognosis of patients with pulmonary embolism depends on two factors : underlying disease state plus diagnosis, and appropriate treatment. Approximately 10% of patients who develop pulmonary embolism die within the first hour, and 30% subsequently die of recurrent embolism.

CASE PRESENTATION: In this presentation we present the case of a 49-year-old male patient without co morbidities, presented repeatedly to the Emergency Room for symptoms suggestive of pulmonary thromboembolism, who benefited from life-saving therapies due to timely diagnosis and appropriate treatment, with subsequent favorable outcome.

CONCLUSIONS: The particularity of the case is that, on the one hand, the thromboembolic event recurred in a short time, on the other hand, the evolution was favorable in both cases, with complete recovery of right ventricular function and disappearance of pulmonary hypertension, despite the fact that the patient was non-compliant with initial anticoagulation therapy. This was due to both early diagnosis and timely administration of appropriate treatment.

 

References

  1. Schulman SRhedin ASLindmarker P et al. Dura-tion of Anticoagulation Trial Study Group, A comparison of six weeks with six months of oral anticoagulant therapy after a first episode of venous thromboembolism. N Engl J Med. 1995;3321661- 1665PubMedGoogle Scholar-Crossref
  2. Kearon CGent MHirsh J et al. A comparison of three months of anticoagulation with extended anticoagulation for a first episode of idiopathic venous thromboembolism. N Engl J Med. 1999;340901-907PubMedGoogle ScholarCrossref
  3. Palareti GLeali NCoccheri S et al. Bleeding com-plications of oral anticoagulant treatment: an in-ception-cohort, prospective collaborative study (ISCOAT): Italian Study on Complications of Oral Anticoagulant Therapy. Lancet. 1996;348423- 428PubMedGoogle ScholarCrossref
  4. van der Meer FJRosendaal FRVandenbroucke JPBriet E Assessment of a bleeding risk index in two cohorts of patients treated with oral antico-agulants. Thromb Haemost. 1996;7612- 16PubMedGoogle Scholar
  5. Levine MNRaskob GLandefeld SKearon C Hem-orrhagic complications of anticoagulant treat-ment. Chest. 2001;119(1, suppl)108S- 113SPubMed Google ScholarCrossref
  6. Schulman SRhedin ASLindmarker P et al. Dura-tion of Anticoagulation Trial Study Group, A comparison of six weeks with six months of oral anticoagulant therapy after a first episode of venous thromboembolism. N Engl J Med. 1995;3321661- 1665PubMedGoogle Scholar-Crossref
  7. Kearon CGent MHirsh J et al. A comparison of three months of anticoagulation with extended anticoagulation for a first episode of idiopathic venous thromboembolism. N Engl J Med. 1999;340901-907PubMedGoogle ScholarCrossref
  8. Pinede LNinet JDuhaut P et al. Comparison of 3 and 6 months of oral anticoagulant therapy after a first episode of proximal deep vein thrombosis or pulmonary embolism and comparison of 6 and 12 weeks of therapy after isolated calf deep vein thrombosis. Circulation. 2001;1032453- 2460PubMedGoogle ScholarCrossref
  9. Agnelli GPrandoni PSantamaria MG et al. Three months versus one year of oral anticoagulant therapy for idiopathic deep venous thrombosis. N Engl J Med. 2001;345165- 169PubMedGoogle ScholarCrossref
  10. Heit JA. Th e epidemiology of venous throm-boembolism in the community. Arterioscler Th romb Vasc Biol 2008;28(3):370–372.
  11. Cohen AT, Agnelli G, Anderson FA, Arcelus JI, Bergqvist D, Brecht JG, Greer IA, Heit JA, Hutchinson JL, Kakkar AK, Mottier D, Oger E, Samama MM, Spannagl M. Venous thrombo-embolism (VTE) in Europe. The number of VTE events and associated morbidity and mortality. Th romb Haemost 2007;98(4):756–764.
  12. Anderson FA Jr., Spencer FA. Risk factors for venous thromboembo-lism. Circulation 2003;107(23 Suppl 1):I9–I16.
  13. Goldhaber SZ: Venous thromboembolism: epi-demiology and magnitude of the problem. Best Pract Res Clin Haematol 25: 235, 2012. [PMID: 22959540]
  14. Logan JK, Pantle H, Huiras P, Bessman E, Bright L: Evidence-based diagnosis and thrombolytic treatment of cardiac arrest or periarrest due to suspected pulmonary embolism. Am J Emerg Med 32: 789, 2014. [PMID: 24856738]
  15. Pollack CV, Schreiber D, Goldhaber SZ, et al: Clinical characteristics, management, and out-comes of patients diagnosed with acute pulmo-nary embolism in the emergency department: ini-tial report of EMPEROR (Multicenter Emergency Medicine Pulmonary Embolism in the Real World Registry). J Am Coll Cardiol 57: 700, 2011. [PMID: 21292129]
  16. Goldhaber SZ, Visani L, De Rosa M. Acute pul-monary embolism: clinical outcomes in the In-ternational Cooperative Pulmonary Embolism Registry (ICOPER). Lancet. 1999 Apr 24. 353(9162):1386-9. [Medline].
  17. Kucher N, Rossi E, De Rosa M, Goldhaber SZ. Massive pulmonary embolism. Circulation. 2006 Jan 31. 113(4):577-82. [Medline].
  18. Meyer G, Planquette B, Sanchez O. Long-term outcome of pulmonary embolism. Curr Opin Hematol. 2008 Sep. 15(5):499-503. [Medline].
  19. Cavallazzi R, Nair A, Vasu T, Marik PE. Natriuretic peptides in acute pulmonary embolism: a sys-tematic review. Intensive Care Med. 2008 Dec. 34(12):2147-56. [Medline].
  20. Alonso-Martínez JL, Urbieta-Echezarreta M, An-niccherico-Sánchez FJ, Abínzano-Guillén ML, Garcia-Sanchotena JL. N-terminal pro-B-type na-triuretic peptide predicts the burden of pulmonary embolism. Am J Med Sci. 2009 Feb. 337(2):88-92. [Medline]