Heparin-induced thrombocytopenia (HIT) is an uncommon but potentially serious adverse effect of heparin therapy and is associated with an increased risk of thrombosis. This case report describes a rare case of probable HIT complicated by cerebral venous sinus thrombosis (CVST) following exposure to low-molecular-weight heparin (LMWH). A 46-year-old man developed severe thrombocytopenia, hypofibrinogenemia, and markedly elevated D-dimer levels nine days after the initiation of prophylactic dalteparin following finger replantation surgery, which ultimately progressed to dry gangrene of the replanted fingers. After discontinuation of argatroban, the patient subsequently developed a severe headache, and neuroimaging revealed sigmoid sinus thrombosis. Confirmatory HIT antibody testing was unavailable in this case. The clinical diagnosis and therapeutic strategy were therefore guided by the 4T score, dynamic laboratory trends, and exclusion of alternative diagnoses rather than serological confirmation of HIT. All heparin products were immediately discontinued, and anticoagulation with the non-heparin agent argatroban was initiated. Because of a temporarily high bleeding risk, anticoagulation was briefly withheld to permit blood product support before transitioning to long-term oral anticoagulation with rivaroxaban. This management strategy resulted in normalization of the platelet count, correction of the coagulopathy, and substantial improvement in CVST on follow-up imaging. This case underscores the importance of considering probable HIT even in patients receiving LMWH, demonstrates the effective sequential use of argatroban followed by a direct oral anticoagulant, and highlights the need for prompt neuroimaging when neurological symptoms develop in patients with probable HIT.
Spontaneous neonatal aortic thrombosis is a rare but life-threatening condition with potentially severe complications, including limb ischemia and organ dysfunction. While hypernatremic dehydration has been occasionally linked to thrombotic events in the absence of central vascular catheterization, such occurrences remain uncommon. We report the case of an eight-day-old full-term male neonate presenting with fever, poor feeding, and severe dehydration associated with hypernatremia. The infant, born to a mother carrying the sickle cell trait, developed hypertension, hepatomegaly, and progressive cyanosis of the left toes, suggesting distal ischemia. Echocardiography and CT angiography revealed a large thrombus in the descending aorta with preserved visceral perfusion and extensive collateral circulation, suggesting with chronic thrombosis of antenatal origin. The patient was managed with unfractionated heparin, followed by systemic thrombolysis with streptokinase, resulting in marked thrombus regression and restoration of perfusion. Neonatal aortic thrombosis, though rare, can be fatal and may arise without iatrogenic risk factors. Imaging is key to assessing thrombus chronicity. Cautious use of systemic thrombolysis may be effective when surgery is not feasible. Long-term monitoring is essential for detecting delayed complications. Not applicable.
Evidence regarding venous thromboembolism (VTE) risk in palliative care populations remains scarce, and current thromboprophylaxis recommendations are largely extrapolated from non-palliative oncology cohorts. This study aimed to determine the 90-day incidence of VTE and associated clinical risk factors in hospitalized patients with advanced cancer receiving palliative care. This multicenter retrospective cohort study included adults with advanced cancer enrolled in a palliative care program who were hospitalized between 2018 and 2024 at two tertiary care centers in Bogotá, Colombia. VTE incidence was calculated, and clinical risk factors were identified using multivariable Cox proportional hazards models. A total of 782 patients were included (mean age 61 years; 58.7
Atrial fibrillation (AF) is the most common arrhythmia in adults and significantly increases the risk of stroke. Due to common threats like systemic inflammation and treatment-related cardiotoxicity, individuals with cancer have a noticeably increased chance of developing AF. Managing AF in this population presents dual challenges: reducing thromboembolic risk while minimizing bleeding complications. Traditionally, warfarin, a vitamin K antagonist, has been the most widely used anticoagulant. However, the emergence of direct oral anticoagulants (DOACs), which offer equal or superior efficacy compared to warfarin with fewer dietary and drug interactions, has shifted clinical practice. This narrative review explores the complex clinical relationship between AF, anticoagulation, and bleeding as a potential early indicator of occult cancer. An expanding body of evidence from extensive cohort studies and meta-analyses supports this association, showing a significantly increased risk of gastrointestinal, genitourinary, respiratory, and, to a lesser extent, intracranial bleeding in anticoagulated patients that may precede cancer diagnosis. Although bleeding is a recognized difficulty of oral anticoagulation, it may expose occult malignancy, resulting in timely detection of cancer and more favorable outcomes. Perhaps it is time to regard occult gastrointestinal bleeding for what it may be: an early warning sign of malignancy. The increased risk of both thromboembolism and bleeding in cancer patients poses a challenge in clinical practice. Though bleeding has increasingly been recognized as a potential harbinger of occult cancer, uniform guidelines for malignant lesion screening after a hemorrhagic episode remain to be established. It is essential to establish a solid, evidence-based therapeutic protocol to achieve the best possible treatment and results for patients.
Catheter-related thrombosis (CRT) is a clinically relevant complication in patients with malignancy receiving central venous access devices, but early individualized risk assessment remains limited. This study developed and internally validated a prediction model incorporating D-dimer, platelet count, and albumin for estimating 30-day CRT risk after catheter placement. This single-center retrospective cohort study included hospitalized adult patients with malignancy who underwent peripherally inserted central catheter (PICC), central venous catheter (CVC), or implantable venous access port (PORT) placement between January 2018 and December 2025. The primary outcome was imaging-confirmed CRT within 30 days after catheter insertion, including both symptomatic events and incidentally detected asymptomatic thrombosis. Core laboratory predictors included log-transformed D-dimer, platelet count, and albumin. Non-core clinical, tumor-related, and catheter-related predictors were selected using least absolute shrinkage and selection operator regression. A multivariable logistic regression model was developed, internally validated using 1,000 bootstrap resamples, and evaluated by discrimination, calibration, decision curve analysis, risk stratification, and sensitivity analyses. Among 1,876 eligible patients, 145 developed 30-day CRT, corresponding to an incidence of 7.73
