Work

Abnormal fibrin clot properties as a potential mechanism of recurrent arterial thrombosis in a young woman: a 10-year follow-up case report

Year: 2026

Type: article

Abstract: Background: Dysfibrinogenemia is responsible for approx. 1% of acute thrombosis events, that is why is not commonly included in diagnostic process. We present a rare case of recurrent arterial thrombosis in two different vascular beds in a young woman without any clear recognized risk factor, followed up for over a ten-year period. Case presentation: A 21-year-old woman without comorbidities or known risk factors was diagnosed with acute lower limb ischemia due to the massive arterial thrombosis. Despite successful targeted fibrinolysis, early reocclusion occurred, requiring surgical embolectomy. One month later, intracranial internal carotid artery occlusion and stenosis of the middle cerebral artery occurred. Basic laboratory tests for thrombophilia and echocardiography revealed no abnormalities. Expanded fibrin properties assessment showed reduced clot permeability and density, prolonged clot lysis time, increased maximum concentration with decreased maximum rate of D-dimer, accompanied by increased fibrin gel absorbance and shortened lag phase. Anticoagulant therapy was set, including 75mg of acetylsalicylic acid and acenocoumarol, replaced with rivaroxaban 15mg after 6 years. One year later, the patient became pregnant, and the therapy was modified to 40mg of low-molecular-weight heparin combined with ASA 75 mg. After an uncomplicated vaginal delivery, 15mg rivaroxaban was resumed, accompanied by ASA. Throughout ten years of the follow up no further thrombotic episodes were observed. Conclusions: This case shows the importance of thorough and accurate diagnosis in patients with unprovoked atypical arterial thrombosis. Optimal therapy, including both invasive and conservative treatment, is needed, increasing the probability of successful outcomes, even when additional risk factors as pregnancy appear.

Source: Thrombosis Journal

DOI: 10.1186/s12959-026-00899-w

Authors: Martyna Schönborn, Paweł Maga, Joanna Zdziarska, Mikołaj Maga

Institutions: Jagiellonian University, Szpital Uniwersytecki w Krakowie

Language: English

Topic: Blood properties and coagulation

Subfield: Pulmonary and Respiratory Medicine

Field: Medicine

Domain: Health Sciences

SDG: Good health and well-being

Open Access status: gold

Estimated APC paid: $3,090