SHM Converge Scientific Abstract ePoster Gallery-Life, Limb, and the Pursuit of Patient Autonomy

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This case report describes a 30-year-old woman with lupus-associated antiphospholipid syndrome and a history of extensive arterial and venous thrombosis who presented with seven days of left leg pain, coolness, and skin blanching after stopping anticoagulation for two months. CT angiography showed widespread arterial occlusion from the left renal artery to the distal peroneal artery, with only tenuous collateral circulation. The vascular surgery team recommended above-knee amputation because acute limb ischemia in antiphospholipid syndrome carries a poor prognosis and high risk of mortality.<br /><br />The patient repeatedly رفضed amputation, believing heparin might restore blood flow and preserve the limb. She also requested input from her out-of-state vascular surgeons, who agreed with the recommendation for amputation. Despite several days of heparin infusion and ongoing counseling, her condition did not improve, and tensions grew between the patient and the care team.<br /><br />To resolve the conflict, the team held a multidisciplinary family meeting on hospital day six. After discussion, they shifted from standard surgical management to a patient-centered plan focused on pain control, continued anticoagulation to prevent further thrombosis, and coordinated follow-up with her preferred vascular team. She was discharged after 15 days, continued anticoagulation at home, and later followed up as an outpatient with close monitoring.<br /><br />The report emphasizes the ethical tension between patient autonomy and clinician non-maleficence. It argues that when a patient has decision-making capacity, clinicians must thoroughly discuss risks, benefits, and alternatives, even when the patient refuses evidence-based recommendations. A holistic, multidisciplinary approach—including support from bioethics, psychology, nursing, pharmacy, or patient advocacy—can help teams reach a respectful and workable plan of care.

Asset Subtitle

Elle Maureen Newcome

Meta Tag

Author List Elle Maureen Newcome, Emily A. Mallin, Jennifer Nelson, Stephanie Wong

Category Clinical Vignettes

Concept Acute Limb Ischemia

Concept Arterial Thrombosis

Concept Patient Autonomy

Concept Decision-Making Capacity

Concept Antiphospholipid Antibody Syndrome

Distinguished Non-Finalist

Presenter Organization University of Arizona College of Medicine Phoenix Internal Medicine Residency Program

Presenting Author Elle Maureen Newcome

Track Adult

Keywords

antiphospholipid syndrome

lupus

acute limb ischemia

arterial thrombosis

venous thrombosis

heparin infusion

above-knee amputation

patient autonomy

multidisciplinary care

bioethics

Acute Limb Ischemia

Arterial Thrombosis

Patient Autonomy

Decision-Making Capacity

Antiphospholipid Antibody Syndrome