What's the Take Home?
A Young Woman With an Unprovoked Deep Vein Thrombosis
Ronald N. Rubin, MD1,2—Series Editor
1Lewis Katz School of Medicine at Temple University, Philadelphia, Pennsylvania
2Department of Medicine, Temple University Hospital, Philadelphia, Pennsylvania
Rubin RN. A young woman with an unprovoked deep vein thrombosis. Consultant. 2020;60(9):17-19. doi:10.25270/con.2020.09.00002
The author reports no relevant financial relationships.
Ronald N. Rubin, MD, Temple University Hospital, 3401 N Broad St, Philadelphia, PA 19140 (firstname.lastname@example.org)
A 31-year-old woman is seen in the office several weeks after having sustained a Doppler ultrasonography–confirmed deep vein thrombosis (DVT) of her left popliteal vein with some extension proximally. She had been treated with apixaban and currently is on maintenance anticoagulation with that agent. Otherwise, her health is excellent, without chronic conditions or major medical diagnoses.
There had been no obvious provoking factor for this DVT. She simply had noticed pain in her leg behind her knee and a degree of unilateral edema on the affected side. She works as an executive in an office and spends much of her time at a desk but is also on her feet many times during the course of the day. And she works out at least 3 times per week at the local fitness gym. She takes no medications other than occasional nonsteroidal anti-inflammatory drugs. She is married and uses a hormonal intrauterine device for contraception and has done so for more than a decade, except when she wished to become pregnant. She has a 2-year-old son and reports a history of a miscarriage 3 years ago, “almost exactly at 12 weeks,” since she considered that the time after which a pregnancy was “safe and confirmed” and likely to proceed.
Her physical examination findings are totally within normal limits, save for residual 1+ edema in the left ankle, which she says is improving daily.
Review of her laboratory test results obtained several weeks ago at her initial DVT presentation revealed a totally normal complete blood cell count and metabolic and biochemical panels, with a creatinine level of 0.9 mg/dL. Coagulation study findings prior to therapy showed an international normalized ratio (INR) of 1.0 and a partial thromboplastin time (PTT) of 36 s (reference range, 22-36 s). Just prior to this office visit, her INR was again 1.0 and her PTT was 38 s. Her creatinine level remains normal. She is here for evaluation of possible antiphospholipid (aPL) syndrome (APS).