Anticoagulation Monitoring in Recurrent Venous Thromboembolism Associated With Antiphospholipid Antibodies and Subsequent Heparin-Induced Thrombocytopenia.
- 1Internal Medicine, Franciscan Health, Munster, USA.
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.
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BibTeX
@article{bechir2026anticoagulation,
title = {{Anticoagulation Monitoring in Recurrent Venous Thromboembolism Associated With Antiphospholipid Antibodies and Subsequent Heparin-Induced Thrombocytopenia.}},
author = {George Bechir},
journal = {Cureus},
year = {2026},
month = oct,
doi = {10.7759/cureus.118258},
url = {https://europepmc.org/article/MED/42904293},
note = {CC BY},
}
RIS
TY - JOUR
TI - Anticoagulation Monitoring in Recurrent Venous Thromboembolism Associated With Antiphospholipid Antibodies and Subsequent Heparin-Induced Thrombocytopenia.
AU - George Bechir
PY - 2026
DA - 2026/10/20
JO - Cureus
DO - 10.7759/cureus.118258
UR - https://europepmc.org/article/MED/42904293
AB - 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.
SN - 2168-8184
ER -