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Rezidivierende Thrombembolien trotz Vollantikoagulation bei Patientin mit Antiphospholipidsyndrom

Recurrent thromboembolisms despite full anticoagulation in a patient with antiphospholipid syndrome

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Zusammenfassung

Wir berichten über eine Patientin mit sekundärem Antiphospholipidsyndrom (APS) bei Lupus erythematodes, die trotz einer Thromboplastinzeit (International Normalized Ratio) im therapeutischen Bereich unter einem Vitamin-K-Antagonisten (VKA) erneut eine Lungenarterienembolie bei beidseitiger tiefer Beinvenenthrombose entwickelte. In der weiteren Gerinnungsdiagnostik zeigte sich trotz INR-Werte im therapeutischen Zielbereich eine unzureichende Suppression der Gerinnungsfaktoren II, VII, IX und X, weshalb von einer ineffektiven Antikoagulation auszugehen war. Mangels Steuerbarkeit der VKA-Therapie entschlossen wir uns zu einer Umstellung auf Dabigatran. Der Fall demonstriert, dass bei APS-Patienten in seltenen Fällen trotz unauffälliger aktivierter partieller Thromboplastinzeit die INR fälschlich verlängert sein kann, weshalb bei Verdacht auf eine ineffektive Antikoagulation unter VKA eine Bestimmung der Einzelgerinnungsfaktoren empfehlenswert ist.

Abstract

We report on a female patient with confirmed secondary antiphospholipid syndrome (APS) due to underlying systemic lupus erythematosus (SLE). Despite a thromboplastin time within the normal range (international normalized ratio, INR) under treatment with a vitamin K antagonist (VKA), a recurrent thrombotic event occurred, this time as pulmonary embolism due to bilateral deep vein thrombosis. Despite an INR value in the therapeutic range, clotting factors II, VII, IX and X were found to be insufficiently decreased suggesting inefficient anticoagulation. Thus, the anticoagulation regimen was changed to the direct oral anticoagulant dabigatran. This case demonstrates that the INR in APS patients may be artificially prolonged in rare cases, despite a normal activated partial thromboplastin time (aPTT) and cannot be used for monitoring VKA anticoagulant therapy. Suspicion of ineffective anticoagulation despite VKA therapy should prompt measurement of the individual clotting factors.

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Authors and Affiliations

  1. Klinik und Poliklinik für Innere Medizin B, Universitätsmedizin Greifswald, Ferdinand-Sauerbruch-Str., 17475, Greifswald, Deutschland

    S. Wernicke, S. B. Felix & F. Hammer

  2. Institut für Immunologie und Transfusionsmedizin, Universitätsmedizin Greifswald, Greifswald, Deutschland

    K. Selleng & A. Greinacher

Authors
  1. S. Wernicke
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  2. K. Selleng
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  3. S. B. Felix
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  4. A. Greinacher
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  5. F. Hammer
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Correspondence to S. Wernicke.

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Interessenkonflikt

S. Wernicke, K. Selleng, S.B. Felix, A. Greinacher und F. Hammer geben an, dass kein Interessenkonflikt besteht.

Dieser Beitrag beinhaltet keine von den Autoren durchgeführten Studien an Menschen oder Tieren. Alle Patienten, die über Bildmaterial oder anderweitige Angaben innerhalb des Manuskripts zu identifizieren sind, haben hierzu ihre schriftliche Einwilligung gegeben.

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H. Haller, Hannover (Schriftleitung)

B. Salzberger, Regensburg

C. C. Sieber, Nürnberg

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Wernicke, S., Selleng, K., Felix, S.B. et al. Rezidivierende Thrombembolien trotz Vollantikoagulation bei Patientin mit Antiphospholipidsyndrom. Internist 58, 735–739 (2017). https://doi.org/10.1007/s00108-017-0211-6

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  • DOI: https://doi.org/10.1007/s00108-017-0211-6

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