International Journal of Hematology

, Volume 91, Issue 4, pp 679–686 | Cite as

Deep vein and intracardiac thrombosis during the post-partum period in Behçet’s disease

  • Prashant Hiwarkar
  • Roberto Stasi
  • George Sutherland
  • Muriel Shannon
Case Report

Abstract

A 22-year-old woman presented on the 10th post-partum day with deep vein thrombosis involving the right ilio-femoral and popliteal veins. This thrombosis was refractory to conventional anticoagulation and subsequently over a period of 6 weeks progressed to involve inferior vena cava and right ventricle. A diagnosis of Behçet’s disease was made on the clinical grounds of fever, night sweats, and recurrent oral ulcers. In view of refractory thrombosis, anticoagulation with lepirudin was commenced followed by thrombolysis with streptokinase. After thrombolysis, anticoagulation was switched to fondaparinux. Intracardiac thrombus, oral ulcers, constitutional symptoms, and inflammatory indices resolved on 20 mg of oral prednisolone. This case highlights that management of thrombosis unresponsive to conventional anticoagulation requires careful consideration of the underlying conditions, the sites of thrombosis, as well as of the available treatment options. Intravenous lepirudin is a valuable therapeutic option when anticoagulation with warfarin or LMWH is not efficacious. Thrombolytic therapy may be used to treat intracardiac thrombi more rapidly, and possibly more efficiently, than surgery. The addition of corticosteroids or other immunosuppressive drugs is necessary in order to achieve a full resolution of thrombosis.

Keywords

Behçet’s disease Intracardiac thrombus Vascular Behçet’s disease Thrombolysis Lepirudin 

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Copyright information

© The Japanese Society of Hematology 2010

Authors and Affiliations

  • Prashant Hiwarkar
    • 1
  • Roberto Stasi
    • 1
  • George Sutherland
    • 2
  • Muriel Shannon
    • 1
  1. 1.Department of HaematologySt. George’s HospitalTootingLondon
  2. 2.Department of CardiologySt. George’s HospitalTootingLondon

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