SHM Converge Scientific Abstract ePoster Gallery-Therapeutic Cul-De-Sac: Refractory Cancer-Associated Thrombosis Complicated by Heparin-Induced Thrombocytopenia in Advanced Pancreatic Cancer

Therapeutic Cul-De-Sac: Refractory Cancer-Associated Thrombosis Complicated by Heparin-Induced Thrombocytopenia in Advanced Pancreatic Cancer

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A 67-year-old woman presented with pleuritic chest pain and dyspnea and was found to have DVTs and pulmonary emboli. Further evaluation revealed metastatic pancreatic cancer with KRAS, MYC, and CDKN2A/B alterations. She underwent mechanical thrombectomy and was initially discharged on apixaban.<br /><br />Her course was marked by repeated thromboembolic recurrences despite multiple anticoagulation strategies. After a second admission for PE extension, she was treated with heparin, but developed heparin-induced thrombocytopenia (HIT), requiring a switch to argatroban and discharge on fondaparinux. She later started mFOLFIRINOX, but was rehospitalized for further PE progression. Additional anticoagulation changes included argatroban, warfarin, and then dabigatran due to unstable INR control. On a fourth admission, she developed extensive clot burden as well as arterial thrombi and strokes while receiving argatroban. She ultimately chose hospice care and died.<br /><br />This case highlights the extreme hypercoagulability associated with advanced pancreatic adenocarcinoma, particularly KRAS-mutated disease. It also demonstrates how cancer-associated thrombosis can become refractory even with multiple anticoagulants and be further complicated by HIT. The report emphasizes the poor prognosis linked to malignancy-driven thrombosis and the importance of recognizing when recurrent thromboembolic events persist despite optimal treatment, prompting timely transition to comfort-focused care.

Asset Subtitle

Parker Meeks

Meta Tag

Author List Lalitha Ranga, Morgan Rachlin, Nicholas Scelzi, Parker Meeks

Category Clinical Vignettes

Concept Pancreatic Adenocarcinoma

Concept Cancer-Associated Venous Thromboembolism

Concept Thromboembolism

Concept Heparin-Induced Thrombocytopenia

Concept Metastatic Disease

Distinguished Non-Finalist

Presenter Organization Department of Internal Medicine, New York Institute of Technology College of Osteopathic Medicine at Arkansas State University, Jonesboro, AR 72401

Presenting Author Parker Meeks

Track Adult

Keywords

pancreatic cancer

thrombosis

pulmonary embolism

deep vein thrombosis

hypercoagulability

KRAS mutation

heparin-induced thrombocytopenia

anticoagulation

mechanical thrombectomy

hospice care

Pancreatic Adenocarcinoma

Cancer-Associated Venous Thromboembolism

Thromboembolism

Heparin-Induced Thrombocytopenia

Metastatic Disease