SHM Converge Scientific Abstract ePoster Gallery-Anticoagulation Management in a Patient With an Ivc Thrombus With Recent Intracranial Hemorrhage and Underlying Amyloid Angiopathy

Anticoagulation Management in a Patient With an Ivc Thrombus With Recent Intracranial Hemorrhage and Underlying Amyloid Angiopathy

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This case report describes the difficult management of venous thromboembolism in a patient with cerebral amyloid angiopathy, a condition that increases the risk of intracranial hemorrhage. A 79-year-old man presented with a spontaneous right frontal intracranial hemorrhage causing hemiparesis and cognitive changes, requiring surgical hematoma evacuation. Several days later, he developed an acute segmental pulmonary embolism. Because anticoagulation was initially contraindicated due to the recent brain bleed, an inferior vena cava (IVC) filter was placed.<br /><br />Before discharge, the patient became hypotensive and syncopal. Imaging showed a large thrombus extending from the IVC filter through the iliofemoral veins to the right popliteal vein. After consultation among vascular medicine, neurology, and interventional radiology, the team decided that anticoagulation was necessary despite bleeding risk. They started a low-intensity heparin infusion, then transitioned him to therapeutic enoxaparin. He improved functionally, tolerated anticoagulation without hemorrhagic complications, and later was switched to apixaban to complete three months of treatment.<br /><br />The report highlights the need for individualized, stepwise decision-making when treating thrombosis in patients with high bleeding risk from cerebral amyloid angiopathy. Careful monitoring and shared decision-making allowed successful treatment without recurrent intracranial bleeding.

Asset Subtitle

Keir MacKay

Meta Tag

Author List Chris A. Dinh, Keir MacKay

Category Clinical Vignettes

Concept Venous Thromboembolism

Concept Anticoagulation

Concept Intracranial Hemorrhage

Concept Cerebral Amyloid Angiopathy

Concept Inferior Vena Cava Filter

Distinguished Non-Finalist

Presenter Organization Mayo Clinic Rochester

Presenting Author Keir MacKay

Track Adult

Keywords

cerebral amyloid angiopathy

intracranial hemorrhage

venous thromboembolism

pulmonary embolism

inferior vena cava filter

anticoagulation

heparin infusion

enoxaparin

apixaban

thrombosis

Venous Thromboembolism

Anticoagulation

Intracranial Hemorrhage

Cerebral Amyloid Angiopathy

Inferior Vena Cava Filter