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CC BY 4.0 · TH Open 2023; 07(03): e262-e269
DOI: 10.1055/a-2161-1262
Case Report

A Patient with Recurrent Strokes: Approach to Coagulopathy

Gabriel Alejandro Zúñiga 
1   School of Medicine, Universidad Católica de Santiago de Guayaquil, Guayaquil, Ecuador
,
Pranav Kandula
2   Division of Cardiology, NorthShore University HealthSystem, Evanston, Illinois, United States
3   College of Engineering, Ohio State University, Columbus, Ohio, United States
,
Hardy Sandefur
2   Division of Cardiology, NorthShore University HealthSystem, Evanston, Illinois, United States
,
Alfonso J. Tafur
2   Division of Cardiology, NorthShore University HealthSystem, Evanston, Illinois, United States
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Abstract

Despite anticoagulation recommendations, patients may present with recurrent events. While medication adherence is always a concern, assessment of anticoagulation failure demands a systematic approach, taking into account the potential limitations of anticoagulants and a review of differential diagnoses for comorbidities. We illustrate our approach in a case presentation.

Keywords

anticoagulation - venous thromboembolism - antiphospholipid antibody syndrome - recurrent strokes


Publication History

Received: 06 April 2023

Accepted: 15 August 2023

Accepted Manuscript online:
28 August 2023

Article published online:
27 September 2023

© 2023. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution License, permitting unrestricted use, distribution, and reproduction so long as the original work is properly cited. (https://creativecommons.org/licenses/by/4.0/)

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  • References

  • 1 Björck F, Renlund H, Lip GYH, Wester P, Svensson PJ, Själander A. Outcomes in a warfarin-treated population with atrial fibrillation. JAMA Cardiol 2016; 1 (02) 172-180
    CrossrefPubMedGoogle Scholar
  • 2 Ebraheem M, Alzahrani I, Crowther M, Rochwerg B, Almakadi M. Extended DOAC therapy in patients with VTE and potential risk of recurrence: a systematic review and meta-analysis. J Thromb Haemost 2020; 18 (09) 2308-2317
    CrossrefPubMedGoogle Scholar
  • 3 Riahi RR, Cohen PR, Robinson FW, Gray JM. Erythema ab igne mimicking livedo reticularis. Int J Dermatol 2010; 49 (11) 1314-1317
    CrossrefPubMedGoogle Scholar
  • 4 Janković A, Binić I, Janković D. Reddish-violet, reticular discoloration on the legs. Am Fam Physician 2012; 85 (09) 907-908
    PubMedGoogle Scholar
  • 5 Andreev VC, Pramatarov K. Cutis mamorata telangiectatica congenita in two sisters. Br J Dermatol 1979; 101 (03) 345-350
    CrossrefPubMedGoogle Scholar
  • 6 Timoney I, Flynn A, Leonard N, Wynne B. Livedo racemosa: a cutaneous manifestation of Sneddon's syndrome. BMJ Case Rep 2019; 12 (11) e232670
    CrossrefPubMedGoogle Scholar
  • 7 Gibbs MB, English III JC, Zirwas MJ. Livedo reticularis: an update. J Am Acad Dermatol 2005; 52 (06) 1009-1019
    CrossrefPubMedGoogle Scholar
  • 8 Bersano A, Morbin M, Ciceri E. et al. The diagnostic challenge of Divry van Bogaert and Sneddon Syndrome: report of three cases and literature review. J Neurol Sci 2016; 364: 77-83
    CrossrefPubMedGoogle Scholar
  • 9 Mitri F, Enk A, Bersano A, Kraemer M. Livedo racemosa in neurological diseases: an update on the differential diagnoses. Eur J Neurol 2020; 27 (10) 1832-1843
    CrossrefPubMedGoogle Scholar
  • 10 Scott RM, Smith ER. Moyamoya disease and moyamoya syndrome. N Engl J Med 2009; 360 (12) 1226-1237
    CrossrefPubMedGoogle Scholar
  • 11 Kraemer M, Schwitalla JC, Diesner F, Aktas O, Hartung HP, Berlit P. Clinical presentation of Moyamoya angiopathy in Europeans: experiences from Germany with 200 patients. J Neurol 2019; 266 (06) 1421-1428
    CrossrefPubMedGoogle Scholar
  • 12 Olmstead J, Olmstead J. A review of antiphospholipid antibody syndrome. J Am Acad Nurse Pract 2001; 13 (10) 460-463 , quiz 464–466
    CrossrefPubMedGoogle Scholar
  • 13 Caldas CA, de Carvalho JF. Primary antiphospholipid syndrome with and without Sneddon's syndrome. Rheumatol Int 2011; 31 (02) 197-200
    CrossrefPubMedGoogle Scholar
  • 14 Francès C, Papo T, Wechsler B, Laporte JL, Biousse V, Piette JC. Sneddon syndrome with or without antiphospholipid antibodies. A comparative study in 46 patients. Medicine (Baltimore) 1999; 78 (04) 209-219
    CrossrefPubMedGoogle Scholar
  • 15 Boesch SM, Plörer AL, Auer AJ. et al. The natural course of Sneddon syndrome: clinical and magnetic resonance imaging findings in a prospective six year observation study. J Neurol Neurosurg Psychiatry 2003; 74 (04) 542-544
    CrossrefPubMedGoogle Scholar
  • 16 Fetoni V, Grisoli M, Salmaggi A, Carriero R, Girotti F. Clinical and neuroradiological aspects of Sneddon's syndrome and primary antiphospholipid antibody syndrome. A follow-up study. Neurol Sci 2000; 21 (03) 157-164
    CrossrefPubMedGoogle Scholar
  • 17 Starmans NLP, Zoetemeyer S, van Dijk MR, Kappelle LJ, Frijns CJM. The diagnostic value of skin biopsies in Sneddon syndrome. PLoS One 2021; 16 (06) e0253365
    CrossrefPubMedGoogle Scholar
  • 18 Lee JS, Kossard S, McGrath MA. Lymphocytic thrombophilic arteritis: a newly described medium-sized vessel arteritis of the skin. Arch Dermatol 2008; 144 (09) 1175-1182
    PubMedGoogle Scholar
  • 19 Vasudevan B, Neema S, Verma R. Livedoid vasculopathy: a review of pathogenesis and principles of management. Indian J Dermatol Venereol Leprol 2016; 82 (05) 478-488
    CrossrefPubMedGoogle Scholar
  • 20 Rosendaal FR, Cannegieter SC, van der Meer FJ, Briët E. A method to determine the optimal intensity of oral anticoagulant therapy. Thromb Haemost 1993; 69 (03) 236-239
    Article in Thieme ConnectPubMedGoogle Scholar
  • 21 Smythe MA, Priziola J, Dobesh PP, Wirth D, Cuker A, Wittkowsky AK. Guidance for the practical management of the heparin anticoagulants in the treatment of venous thromboembolism. J Thromb Thrombolysis 2016; 41 (01) 165-186
    CrossrefPubMedGoogle Scholar
  • 22 Dufrost V, Risse J, Reshetnyak T. et al. Increased risk of thrombosis in antiphospholipid syndrome patients treated with direct oral anticoagulants. Results from an international patient-level data meta-analysis. Autoimmun Rev 2018; 17 (10) 1011-1021
    CrossrefPubMedGoogle Scholar
  • 23 Tektonidou MG, Andreoli L, Limper M. et al. EULAR recommendations for the management of antiphospholipid syndrome in adults. Ann Rheum Dis 2019; 78 (10) 1296-1304
    CrossrefPubMedGoogle Scholar
  • 24 Cuker A, Arepally GM, Chong BH. et al. American Society of Hematology 2018 guidelines for management of venous thromboembolism: heparin-induced thrombocytopenia. Blood Adv 2018; 2 (22) 3360-3392
    CrossrefPubMedGoogle Scholar
  • 25 Shetty R, Seddighzadeh A, Parasuraman S, Vallurupalli NG, Gerhard-Herman M, Goldhaber SZ. Once-daily fondaparinux monotherapy without warfarin for long-term treatment of venous thromboembolism. Thromb Haemost 2007; 98 (06) 1384-1386
    Article in Thieme ConnectPubMedGoogle Scholar
  • 26 Dentali F, Manfredi E, Crowther M, Ageno W. Long-duration therapy with low molecular weight heparin in patients with antiphospholipid antibody syndrome resistant to warfarin therapy. J Thromb Haemost 2005; 3 (09) 2121-2123
    CrossrefPubMedGoogle Scholar
  • 27 Bounameaux H, de Moerloose P. Is laboratory monitoring of low-molecular-weight heparin therapy necessary? No. J Thromb Haemost 2004; 2 (04) 551-554
    CrossrefPubMedGoogle Scholar
  • 28 Khamashta MA, Cuadrado MJ, Mujic F, Taub NA, Hunt BJ, Hughes GR. The management of thrombosis in the antiphospholipid-antibody syndrome. N Engl J Med 1995; 332 (15) 993-997
    CrossrefPubMedGoogle Scholar
  • 29 Lorenzo D, Elisa T, Bianca O. et al. Efficacy of anti-CD monoclonal antibody in SLE-related Sneddon's syndrome with antiphospholipid antibodies and interstitial lung disease: a case report. Clin Case Rep 2020; 10: 1341
    PubMedGoogle Scholar
  • 30 Robert A, Le Querrec A, Delahousse B. et al. Control of oral anticoagulation in patients with the antiphospholipid syndrome–influence of the lupus anticoagulant on International Normalized Ratio. Groupe Méthodologie en Hémostase du Groupe d'Etudes sur l'Hémostases et la Thrombose. Thromb Haemost 1998; 80 (01) 99-103
    PubMedGoogle Scholar
  • 31 Ferrazzi P, Colombo A, Di Micco P. et al. Differences in the INR evaluation of two different thromboplastins in patients with positivity to lupus anticoagulant in ongoing oral anticoagulation. J Blood Med 2010; 1: 57-60
    PubMedGoogle Scholar
  • 32 Baumann Kreuziger LM, Datta YH, Johnson AD, Zantek ND, Shanley R, Reding MT. Monitoring anticoagulation in patients with an unreliable prothrombin time/international normalized ratio: factor II versus chromogenic factor X testing. Blood Coagul Fibrinolysis 2014; 25 (03) 232-236
    CrossrefPubMedGoogle Scholar
  • 33 Gudmundsdottir BR, Francis CW, Bjornsdottir AM, Nellbring M, Onundarson PT. Critical role of factors II and X during coumarin anticoagulation and their combined measurement with a new Fiix-prothrombin time. Thromb Res 2012; 130 (04) 674-681
    CrossrefPubMedGoogle Scholar
  • 34 Sanfelippo MJ, Zinsmaster W, Scherr DL, Shaw GR. Use of chromogenic assay of factor X to accept or reject INR results in Warfarin treated patients. Clin Med Res 2009; 7 (03) 103-105
    CrossrefPubMedGoogle Scholar
  • 35 Onundarson PT, Francis CW, Indridason OS. et al. Fiix-prothrombin time versus standard prothrombin time for monitoring of warfarin anticoagulation: a single centre, double-blind, randomised, non-inferiority trial. Lancet Haematol 2015; 2 (06) e231-e240 [published correction appears in Lancet Haematol 2015 Dec;2(12):e515]
    CrossrefPubMedGoogle Scholar
  • 36 Connolly SJ, Pogue J, Eikelboom J. et al; ACTIVE W Investigators. Benefit of oral anticoagulant over antiplatelet therapy in atrial fibrillation depends on the quality of international normalized ratio control achieved by centers and countries as measured by time in therapeutic range. Circulation 2008; 118 (20) 2029-2037
    CrossrefPubMedGoogle Scholar
  • 37 Hakeam HA, Al-Sanea N. Effect of major gastrointestinal tract surgery on the absorption and efficacy of direct acting oral anticoagulants (DOACs). J Thromb Thrombolysis 2017; 43 (03) 343-351
    CrossrefPubMedGoogle Scholar
  • 38 Leong R, Chu DK, Crowther MA, Mithoowani S. Direct oral anticoagulants after bariatric surgery-what is the evidence?. J Thromb Haemost 2022; 20 (09) 1988-2000
    CrossrefPubMedGoogle Scholar
  • 39 Wiggins BS, Dixon DL, Neyens RR, Page II RL, Gluckman TJ. Select drug-drug interactions with direct oral anticoagulants: JACC review topic of the week. J Am Coll Cardiol 2020; 75 (11) 1341-1350
    CrossrefPubMedGoogle Scholar
  • 40 McBane II RD, Wysokinski WE, Le-Rademacher JG. et al. Apixaban and dalteparin in active malignancy-associated venous thromboembolism: the ADAM VTE trial. J Thromb Haemost 2020; 18 (02) 411-421
    CrossrefPubMedGoogle Scholar
  • 41 Raskob GE, van Es N, Verhamme P. et al; Hokusai VTE Cancer Investigators. Edoxaban for the treatment of cancer-associated venous thromboembolism. N Engl J Med 2018; 378 (07) 615-624
    CrossrefPubMedGoogle Scholar
  • 42 Agnelli G, Becattini C, Meyer G. et al; Caravaggio Investigators. Apixaban for the treatment of venous thromboembolism associated with cancer. N Engl J Med 2020; 382 (17) 1599-1607
    CrossrefPubMedGoogle Scholar
  • 43 Finazzi G, Marchioli R, Brancaccio V. et al. A randomized clinical trial of high-intensity warfarin vs. conventional antithrombotic therapy for the prevention of recurrent thrombosis in patients with the antiphospholipid syndrome (WAPS). J Thromb Haemost 2005; 3 (05) 848-853
    CrossrefPubMedGoogle Scholar
  • 44 Crowther MA, Ginsberg JS, Julian J. et al. A comparison of two intensities of warfarin for the prevention of recurrent thrombosis in patients with the antiphospholipid antibody syndrome. N Engl J Med 2003; 349 (12) 1133-1138 [published correction appears in N Engl J Med 2003 Dec 25;349(26):2577] [published correction appears in N Engl J Med 2004 Jul 8;351(2):200]
    CrossrefPubMedGoogle Scholar
  • 45 Levine SR, Brey RL, Tilley BC. et al; APASS Investigators. Antiphospholipid antibodies and subsequent thrombo-occlusive events in patients with ischemic stroke. JAMA 2004; 291 (05) 576-584
    CrossrefPubMedGoogle Scholar
  • 46 Futrell N, Millikan CH. Prevention of recurrent stroke in patients with systemic lupus erythematosus or lupus anticoagulant. J Stroke Cerebrovasc Dis 1991; 1 (01) 9-20
    CrossrefPubMedGoogle Scholar
  • 47 Seiffge DJ, De Marchis GM, Koga M. et al; RAF, RAF-DOAC, CROMIS-2, SAMURAI, NOACISP, Erlangen, and Verona registry collaborators. Ischemic stroke despite oral anticoagulant therapy in patients with atrial fibrillation. Ann Neurol 2020; 87 (05) 677-687
    CrossrefPubMedGoogle Scholar
  • 48 Jang H, Lee JJ, Lee MJ. et al. Comparison of enoxaparin and warfarin for secondary prevention of cancer-associated stroke. J Oncol 2015; 2015: 502089
    CrossrefPubMedGoogle Scholar
  • 49 Naganuma M, Isoda K, Nishi S, Ito K, Hirano T. Repeated episodes of ischemic stroke over a short period in a patient with essential thrombocythemia on anticoagulant therapy. J Stroke Cerebrovasc Dis 2014; 23 (01) 166-168
    CrossrefPubMedGoogle Scholar
  • 50 Basnet S, Stauffer T, Jayswal A, Tharu B. Recurrent nonbacterial thrombotic endocarditis and stroke on anticoagulation. J Community Hosp Intern Med Perspect 2020; 10 (05) 466-469
    CrossrefPubMedGoogle Scholar