Case Report
Copyright ©The Author(s) 2024. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. Mar 26, 2024; 12(9): 1704-1711
Published online Mar 26, 2024. doi: 10.12998/wjcc.v12.i9.1704
Challenging anticoagulation therapy for multiple primary malignant tumors combined with thrombosis: A case report and review of literature
Jia-Xin Chen, Ling-Ling Xu, Jing-Ping Cheng, Xun-Hua Xu
Jia-Xin Chen, Ling-Ling Xu, Department of Gerontology, China Resources and Wisco General Hospital, Wuhan University of Science and Technology, Wuhan 430080, Hubei Province, China
Jia-Xin Chen, Ling-Ling Xu, Medical College, Wuhan University of Science and Technology, Wuhan 430065, Hubei Province, China
Jing-Ping Cheng, Department of Gerontology, China Resources and Wisco General Hospital, Wuhan 430080, Hubei Province, China
Xun-Hua Xu, Department of Radiology, China Resources and Wisco General Hospital, Wuhan 430080, Hubei Province, China
Co-first authors: Jia-Xin Chen and Ling-Ling Xu.
Co-corresponding authors: Jing-Ping Cheng and Xun-Hua Xu.
Author contributions: Chen JX and Xu LL contributed to manuscript writing and editing, and data collection; Cheng JP and Xu XH were responsible for conceptualization, supervision and communication contacts. All authors were involved in the critical review of the results and have contributed to, read, and approved the final manuscript. The reasons for designating Cheng JP and Xu XH as co-corresponding authors are threefold. First, the research was performed as a collaborative effort, and the designation of co-corresponding authorship accurately reflects the distribution of responsibilities and burdens associated with the time and effort required to complete the study and the resultant paper. This also ensures effective communication and management of post-submission matters, ultimately enhancing the paper's quality and reliability. Second, the overall research team encompassed authors with a variety of expertise and skills from different fields, and the designation of co-corresponding authors best reflects this diversity. This also promotes the most comprehensive and in-depth examination of the research topic, ultimately enriching readers' understanding by offering various expert perspectives. Third, Cheng JP and Xu XH contributed efforts of equal substance throughout the research process. The choice of these researchers as co-corresponding authors acknowledges and respects this equal contribution, while recognizing the spirit of teamwork and collaboration of this study. In summary, we believe that designating Cheng JP and Xu XH as co-corresponding authors of is fitting for our manuscript as it accurately reflects our team's collaborative spirit, equal contributions, and diversity.
Informed consent statement: Informed consent of the patient for publication, including personal data and pictures.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
CARE Checklist (2016) statement: The authors have read the CARE Checklist (2016), and the manuscript was prepared and revised according to the CARE Checklist (2016).
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Jing-Ping Cheng, Doctor, DPhil, Chief Doctor, China Resources and Wisco General Hospital, China Resources and Wisco General Hospital, No. 29 Metallurgical Avenue, Qingshan District, Wuhan 430080, Hubei Province, China. 404178516@qq.com
Received: January 24, 2024
Peer-review started: January 24, 2024
First decision: February 8, 2024
Revised: February 21, 2024
Accepted: March 1, 2024
Article in press: March 1, 2024
Published online: March 26, 2024
Processing time: 61 Days and 7.4 Hours
Abstract
BACKGROUND

Venous thromboembolism significantly contributes to patient deterioration and mortality. Management of its etiology and anticoagulation treatment is intricate, necessitating a comprehensive consideration of various factors, including the bleeding risk, dosage, specific anticoagulant medications, and duration of therapy. Herein, a case of lower extremity thrombosis with multiple primary malignant tumors and high risk of bleeding was reviewed to summarize the shortcomings of treatment and prudent anticoagulation experience.

CASE SUMMARY

An 83-year-old female patient was admitted to the hospital due to a 2-wk history of left lower extremity edema that had worsened over 2 d. Considering her medical history and relevant post-admission investigations, it was determined that the development of left lower extremity venous thrombosis and pulmonary embolism in this case could be attributed to a combination of factors, including multiple primary malignant tumors, iliac venous compression syndrome, previous novel coronavirus infection, and inadequate treatment for prior thrombotic events. However, the selection of appropriate anticoagulant medications, determination of optimal drug dosages, and establishment of an appropriate duration of anticoagulation therapy were important because of concurrent thrombocytopenia, decreased quantitative fibrinogen levels, and renal insufficiency.

CONCLUSION

Anticoagulant prophylaxis should be promptly initiated in cases of high-risk thrombosis. Individualized anticoagulation therapy is required for complex thrombosis.

Keywords: Venous thromboembolism; Cancer-associated thrombosis; Anticoagulation therapy; iliac vein compression syndrome; COVID-19; Thrombocytopenia; Case report

Core Tip: Lung cancer and pancreatic cancer form a rare combination of multiple primary malignant tumors. This patient had a rare lower extremity venous thrombosis complicated by pulmonary embolism. Its causes included a history of various malignant tumors, recent novel coronavirus infection, insufficient anticoagulant therapy for previous lower extremity thrombosis, and iliac vein compression syndrome. Anticoagulant therapy poses challenges to patients with active cancer and reduced fibrinogen levels; abnormally elevated D-dimer levels; and decreased platelet counts. This article provides a comprehensive overview of the therapeutic options for anticoagulation.