Journal of Clinical Case Reports

A Case Report to Estimate Approximately 5 to 8% of the PE Patients has Inherited Thrombophilia′s I

Abstract

Mitevska I

A 42-year-old, previously healthy woman, admitted to our emergency department with first episode of severe
dyspnea and chest pain, hemodynamically stable. She has no history of previous cardiovascular or respiratory
disease, no history of PE or DVT. She had elevated D-dimers. Urgent echocardiography showed indirect signs of
PE, which was confirmed by pulmonary artery CT angiography, which showed massive PE. After two days of heparin
infusion she developed hemodynamic instability with cardiogenic shock, treated successfully with fibrinolysis. The
thrombophilia profile was done two weeks after stopping therapy with rivaroxaban after six months. Thrombophilia
panel came back positive for high levels of homocysteine (67 μmol/L), with other thrombophilia results within normal
limits. Pulmonary embolism should be always suspected in younger patients with acute severe dyspnea event without
provocable risk factors. High suspicion level and fast diagnosis are lifesaving. In younger patients presenting with
unprovoked pulmonary emboli, clinicians should consider inherited prothrombotic factors and homocystinemia as a
potential cause. Longer anticoagulation therapy should be considered in these cases with novel oral anticoagulants
as recommended safer and superior therapy.