Abnormal fibrin clot properties as a potential mechanism of recurrent arterial thrombosis in a young woman: a 10-year follow-up case report
4 affiliations
- 1Department of Angiology, Faculty of Medicine, Jagiellonian University Medical College, Krakow, Poland
- 2Clinical Department of Angiology, University Hospital in Krakow, Krakow, Poland
- 3Department of Hematology and Internal Medicine, University Hospital in Krakow, Krakow, Poland
- 4Department of Rheumatology and Immunology, Faculty of Medicine, Jagiellonian University Medical College, Krakow, Poland
Abstract
Background: The prevalence of dysfibrinogenemia among patients with venous or arterial thrombosis is very low, so it is not commonly included in a diagnostic process. We present a rare case of recurrent arterial thrombosis in two different vascular beds in a young woman without any clear recognized risk factor, followed up for over a ten-year period.
Case presentation: A 21-year-old woman without comorbidities or known risk factors was diagnosed with acute lower limb ischemia due to massive arterial thrombosis. Despite successful targeted fibrinolysis, early reocclusion occurred, requiring surgical embolectomy. One month later, intracranial internal carotid artery occlusion and stenosis of the middle cerebral artery occurred. Basic laboratory tests for thrombophilia and echocardiography revealed no abnormalities. Expanded fibrin properties assessment showed reduced clot permeability and density, prolonged clot lysis time, increased maximum concentration with decreased maximum rate of D-dimer, accompanied by increased fibrin gel absorbance and shortened lag phase. Anticoagulant therapy was initiated with acetylsalicylic acid (75 mg daily) and acenocoumarol. After 6 years, acenocoumarol was replaced with rivaroxaban (15 mg daily). One year later, the patient became pregnant, and her antithrombotic regimen was changed to low-molecular-weight heparin (60 mg daily) combined with aspirin (75 mg daily). Following an uncomplicated vaginal delivery, rivaroxaban (15 mg daily) and aspirin were resumed. During the 10-year follow-up, no further thrombotic events were observed.
Conclusions: This case shows the importance of thorough and accurate diagnosis in patients with unprovoked atypical arterial thrombosis. Optimal therapy, including both invasive and conservative treatment, is needed, increasing the probability of successful outcomes, even when additional risk factors as pregnancy appear.
Clinical trial number: Not applicable.
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BibTeX
@article{schonborn2026abnormal,
title = {{Abnormal fibrin clot properties as a potential mechanism of recurrent arterial thrombosis in a young woman: a 10-year follow-up case report}},
author = {Martyna Schönborn and Paweł Maga and Joanna Zdziarska and Mikołaj Maga},
journal = {Thrombosis Journal},
year = {2026},
month = jul,
doi = {10.1186/s12959-026-00899-w},
url = {https://doi.org/10.1186/s12959-026-00899-w},
note = {CC BY-NC-ND 4.0},
}
RIS
TY - JOUR
TI - Abnormal fibrin clot properties as a potential mechanism of recurrent arterial thrombosis in a young woman: a 10-year follow-up case report
AU - Martyna Schönborn
AU - Paweł Maga
AU - Joanna Zdziarska
AU - Mikołaj Maga
PY - 2026
DA - 2026/07/01
JO - Thrombosis Journal
DO - 10.1186/s12959-026-00899-w
UR - https://doi.org/10.1186/s12959-026-00899-w
AB - Background: The prevalence of dysfibrinogenemia among patients with venous or arterial thrombosis is very low, so it is not commonly included in a diagnostic process. We present a rare case of recurrent arterial thrombosis in two different vascular beds in a young woman without any clear recognized risk factor, followed up for over a ten-year period. Case presentation: A 21-year-old woman without comorbidities or known risk factors was diagnosed with acute lower limb ischemia due to massive arterial thrombosis. Despite successful targeted fibrinolysis, early reocclusion occurred, requiring surgical embolectomy. One month later, intracranial internal carotid artery occlusion and stenosis of the middle cerebral artery occurred. Basic laboratory tests for thrombophilia and echocardiography revealed no abnormalities. Expanded fibrin properties assessment showed reduced clot permeability and density, prolonged clot lysis time, increased maximum concentration with decreased maximum rate of D-dimer, accompanied by increased fibrin gel absorbance and shortened lag phase. Anticoagulant therapy was initiated with acetylsalicylic acid (75 mg daily) and acenocoumarol. After 6 years, acenocoumarol was replaced with rivaroxaban (15 mg daily). One year later, the patient became pregnant, and her antithrombotic regimen was changed to low-molecular-weight heparin (60 mg daily) combined with aspirin (75 mg daily). Following an uncomplicated vaginal delivery, rivaroxaban (15 mg daily) and aspirin were resumed. During the 10-year follow-up, no further thrombotic events were observed. Conclusions: This case shows the importance of thorough and accurate diagnosis in patients with unprovoked atypical arterial thrombosis. Optimal therapy, including both invasive and conservative treatment, is needed, increasing the probability of successful outcomes, even when additional risk factors as pregnancy appear. Clinical trial number: Not applicable.
SN - 1477-9560
ER -