Cahill RA, Redmond HP. Postoperative phlegmasia caerulea dolens: a case report and consideration of potential iatrogenic factors.
J Med Case Rep 2007;
1:163. [PMID:
18053154 PMCID:
PMC2222673 DOI:
10.1186/1752-1947-1-163]
[Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2007] [Accepted: 12/01/2007] [Indexed: 11/15/2022] Open
Abstract
While the haemorrhagic consequences of anti-coagulants are well and frequently described in the surgical literature, the paradoxical prothrombotic tendencies of these drugs tend to be under-recognised due, perhaps, to their clinical infrequency. However, when these effects pertain, their consequences can be devastating. Here, we present a postoperative oncology patient who suffered a massive recrudescence of his lower limb venous thrombosis immediately after discontinuation of his heparin infusion, despite seemingly being adequately anticoagulated by warfarin therapy (INR > 2.0). We intend this case to graphically illustrate the theoretical considerations that must govern the perioperative use of these drugs in high-risk patients.
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