A case of multiple thrombotic diatheses discovered in the setting of mesenteric venous infarction is discussed. The patient had deficiencies of protein C, protein S, antithrombin III; was heterozygous for factor V Leiden; and had polycythemia vera. Adequate anticoagulation could not be established with heparin administration and hirudin was used. The diagnosis of mesenteric venous infarction, thrombotic tendency of multiple coagulation diatheses, and use of hirudin are discussed.
Font VE, Hermann RE, Longworth DL.Chronic mesenteric venous thrombosis: difficult diagnosis and therapy. Cleve Clin J Med1989; 56(8): 823-828.
8.
Gehl HB, Bohndorf K, Klose KC, Gunther RW.Two-dimensional MR angiography in the evaluation of abdominal veins with gradient refocused sequences. J Comput Assist Tomogr1990; 14(4): 619-624.
9.
Grieshop RJ, Dalsing MC, Cikrit DF, Lalka SG, Sawchuk AP.Acute mesenteric venous thrombosis. Revisited in a time of diagnostic clarity. Am Surg1991; 57(9): 573-578.
10.
Miletich JP.Thrombophilia as a multigenic disorder. Semin Thromb Hemost1998; 24 (Suppl). 13-20.
11.
Tait RC, Walker ID, Reitsma PHet al.Prevalence of protein C deficiency in the healthy population. Thromb Haemost1995; 73: 87-93.
12.
Ridker PM, Miletich JP, Hennekens CH, Buring JE.Ethnic distribution of factor V Leiden in 4047 men and women. Implications for venous thromboembolism screening. JAMA1997; 277: 1305-1307.
13.
Bucalossi A, Marotta G, Bigazzi C, Galieni P, Dispensa E.Reduction of antithrombin III, protein C, and protein S levels and activated protein C resistance in polycythemia vera and essential thrombocythemia patients with thrombosis. Am J Hematol1996; 52: 14-20.
14.
Mustafa S, Mannhalter C, Rintelen C, Kyrle PA, Lechner K, Pabinger I.Clinical features of thrombophilia in families with gene defects in protein C or protein S combined with factor V Leiden. Blood Coag Fibrin1998; 9: 85-89.
15.
Conlan MG, Haire WD.Low protein S in essential thrombocythemia with thrombosis. Am J Hematol1989; 32: 88-93.
16.
Koeleman BP, Reitsma PH, Allaart CF, Bertina RM.Activated protein C resistance as an additional risk factor for thrombosis in protein C-deficient families. Blood1994; 84: 1031-1035.
17.
Price DT, Ridker PM.Factor V Leiden mutation and the risks for thromboembolic disease: a clinical perspective. Ann Intern Med1997; 127: 895-903.
18.
Maurer B, Wray R, Shillingford J.Frequency of venous thrombosis after myocardial infarction. Lancet1971; ii: 1385-1387.
19.
McCarthy S, Turner J, Robertson D, Hawkey C.Low-dose heparin as a prophylaxis against deep-vein thrombosis after acute stroke. Lancet1977; ii: 800-801.
20.
Gelmers H.Effects of low-dose subcutaneous heparin on the occur-rence of deep vein thrombosis in patients with ischemic stroke. Acta Neurol Scand1980; 61: 313-318.
21.
Warlow C, Beattie A, Terry G, Ogston D, Kenmure A, Douglas A.A double-blind trial of low doses of subcutaneous heparin in the prevention of deep-venous thrombosis after myocardial infarction. Lancet1973; ii: 934-936.
22.
Ewenstein BM.Antithrombotic agents and thromboembolic disease. N Engl J Med1997; 337: 1383-1384.
23.
Visentin GP, Ford SE, Scott JP, Aster RH.Antibodies from patients with heparin-induced-thrombocytopenia/thrombosis are specific for platelet factor 4 complexed with heparin or bound to endothelial cells. J Clin Invest1994; 93: 81-88.
24.
Hirsh J.Heparin (comments). N Engl J Med1991; 324(22): 1565-1574.
25.
Ludwig DJ, Hauptmann E, Rosoff L Jr, Neuzil D.Mesenteric and portal vein thrombosis in a young patient with protein S deficiency treated with urokinase via the superior mesenteric artery. J Vasc Surg1999; 30(3): 551-554.
26.
Eriksson BI, Ekman S, Kalebo P, Zachrisson B, Bach D, Close P.Prevention of deep-vein thrombosis after total hip replacement: direct thrombin inhibition with recombinant hirudin, CGP 39393. Lancet1996; 347: 635-639.
27.
Eriksson BI, Wille-Jorgensen P, Mouret Pet al.A comparison of recombinant hirudin with a low-molecular-weight heparin to prevent thromboembolic complications after total hip replacement. N Engl J Med1997; 337: 1329-1335.
28.
Monreal M, Costa J, Salva P.Pharmacological properties of hirudin and its derivatives. Potential clinical advantages over heparin. Drugs Aging1996; 8: 171-182.
29.
Song X, Huhle G, Wang L, Hoffman U, Harenberg J.Generation of anti-hirudin antibodies in heparin-induced thrombocytopenic patients treated with r-hirudin. Circulation1999; 100(14): 1528-1532.
30.
Abu-Hajir M, Mazzeo A.The Pharmacology of antithrombotic and antiplatelet agents. Anesthesiol Clinics N Am1999; 17(4): 749-786.