{
  "abstract": "A woman in her 20s with class III obesity and strongly positive antiphospholipid antibodies developed phlegmasia cerulea dolens and a new pulmonary embolus after recent catheter-directed thrombolysis. Before the first documented heparin administration, activated partial thromboplastin time was 95.5 s and international normalized ratio was 1.5. Eight subsequent paired samples showed activated partial thromboplastin times of 176 s to over 200 s with heparin anti-Xa activity of 0.20-0.66 IU/mL. Lupus anticoagulant testing was uninterpretable during anticoagulation, and international normalized ratio reliability was not independently established. Later thrombocytopenia prompted repeat heparin-induced thrombocytopenia testing despite an earlier negative result; a strongly positive immunoassay supported the treating team's diagnosis and transition to fondaparinux. This case illustrates the importance of selecting appropriate anticoagulation monitoring from the outset and reassessing heparin-induced thrombocytopenia when the clinical picture changes. Whether assay interference contributed to recurrent thrombosis remains unresolved.",
  "abstract_shown": true,
  "affiliations": [
    "Internal Medicine, Franciscan Health, Munster, USA."
  ],
  "article_type": null,
  "arxiv": null,
  "author_total": 1,
  "authors": [
    {
      "affs": [
        0
      ],
      "name": "George Bechir"
    }
  ],
  "bibtex": "https://research.draconitic.com/paper/cw1gpbttxxqxr.bib",
  "cited_by": 0,
  "doi": "10.7759/cureus.118258",
  "fulltext_url": "https://europepmc.org/articles/PMC13682851",
  "id": "cw1gpbttxxqxr",
  "issns": [
    "2168-8184"
  ],
  "landing_url": "https://europepmc.org/article/MED/42904293",
  "language": "eng",
  "licence": "CC-BY",
  "licence_label": "CC BY",
  "licence_source": "article",
  "licence_url": "https://creativecommons.org/licenses/by/4.0/",
  "metadata_licence": null,
  "native_subjects": [
    [
      "openalex",
      "2746|Heparin-Induced Thrombocytopenia and Thrombosis"
    ]
  ],
  "openalex": "W7223027582",
  "pdf_url": "https://europepmc.org/articles/PMC13682851?pdf=render",
  "pmcid": "PMC13682851",
  "pmid": "42904293",
  "published": "2026-10-20",
  "publisher": null,
  "ris": "https://research.draconitic.com/paper/cw1gpbttxxqxr.ris",
  "sources": [
    {
      "first_seen": "2026-10-30T12:19:53Z",
      "native_id": "MED:42904293",
      "source": "europepmc",
      "url": "https://europepmc.org/article/MED/42904293"
    }
  ],
  "subjects": [
    {
      "field": "medicine",
      "origin": "openalex:2746|Heparin-Induced Thrombocytopenia and Thrombosis",
      "subfield": "surgery"
    }
  ],
  "title": "Anticoagulation Monitoring in Recurrent Venous Thromboembolism Associated With Antiphospholipid Antibodies and Subsequent Heparin-Induced Thrombocytopenia.",
  "title_text": "Anticoagulation Monitoring in Recurrent Venous Thromboembolism Associated With Antiphospholipid Antibodies and Subsequent Heparin-Induced Thrombocytopenia.",
  "type": "peer-reviewed",
  "updated_at": "2026-10-30T12:19:53Z",
  "url": "https://research.draconitic.com/paper/cw1gpbttxxqxr",
  "venue": "Cureus",
  "versions": []
}