Abstract 338: Patient with Triple Threat Survives DVT and Pulmonary Embolism Complication

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Introduction The risk factors for DVT and complication of PE are firmly documented in literature. Virchow’s triad describes the three most common categories responsible for venous thrombosis occurrence: Hypercoagulation, Stasis and Endothelial Injury. Our patient was diagnosed with near fatal episode of DVT and PE as a result of all 3 risk categories in combination, based on iatrogenic and inherited causes. Discussion Patient presented with left leg edema and shortness of breath. He described recent arthroscopic surgery performed on left knee for meniscal tear. Listed home medications included testosterone supplement for muscle building purposes. Furthermore, patient’s family history provided vague details about possible history of blood clots on maternal side. Patient physical examination pertinent demonstrated left lower extremity edema and tenderness on palpation. Imaging - CT scan showed multiple PE, saddle PE and lower extremity Doppler sonogram provided evidence of DVT in left femoral and popliteal vein. Further evaluation into hypercoagulation disorders showed that patient had an inherited condition of Protein C deficiency. Summary Our patient’s etiology for occurrence of DVT and PE was identified with utilization of history, physical examination, imaging and laboratory investigation. The unique combination of iatrogenic (surgery and testosterone use) and non-iatrogenic (inherited) risk factors resulting in this patient’s clinical diagnosis are an important reminder to clinicians of all specialties to consider various elements of Virchow’s triad when approached with problem of venous thrombosis. Our patient demonstrates a classic element of each - endothelial injury (recent knee surgery), stasis (limited weight bearing post operatively), hypercoagulation (testosterone use and Protein C deficiency). Economic burden of DVT, PE remains high and is often associated with post thrombotic complications mounting economic and clinical expenditure. Timely detection, appropriate therapy and provider education about high risk population has the potential for clinical and economic benefit. Our patient was placed on anticoagulation, counseled about testosterone use, and Protein C deficiency condition.