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Submitted
July 12, 2021
Accepted
July 22, 2021
Published
August 29, 2021
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Abstract
Antiphospolypid síndrome (APS) is a systemic autoimmune condition that is related to vascular thrombosis. Patients with APS are at risk for developing pulmonary embolism (PE) events. In this case, we present a 68 years old female with complaints of sudden onset of persistent shortness of breath for two days. No past medical history was identified. Physical and diagnostic examination revealed the presence of PE and antiphospolipid antibodies. Diagnosis of PE and APS were made. Patients then received initial anticoagulant using enoxaparin subcutaneously. Initial anticoagulants in patients with APS and PE should be administered. However, it is important to choose the right anticoagulant. DOAC is contraindicated due to the increased risk of thromboembolic events.
Keywords
pulmonary embolism
antiphospholipid syndrome
revised geneva
direct anticoagulant
Article Details
How to Cite
Purwowiyoto, S. L., M, F., R, Y., Halomoan, R. ., & Kurniawan. (2021). PULMONARY EMBOLISM WITH ANTIPHOSPHOLIPID SYNDROME: A CASE REPORT. Sanus Medical Journal, 2(2), 9–13. https://doi.org/10.22236/sanus.v2i2.7256
References
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1. Morrone D, Morrone V. Acute Pulmonary Embolism: Focus on the Clinical Picture. Korean Circ J. 2018;48(5):365-381.
2. Turetz M, Sideris AT, Friedman OA, Triphathi N, Horowitz JM. Epidemiology, Pathophysiology, and Natural History of Pulmonary Embolism. Semin Intervent Radiol. 2018;35(2):92-98.
3. Na YS, Jang S, Hong S, Oh YM, Lee SD, Lee JS. Clinical Phenotype of a First Unprovoked Acute Pulmonary Embolism Associated with Antiphospholipid Antibody Syndrome. Tuberc Respir Dis (Seoul). 2019;82(1):53-61.
4. Gómez-Puerta JA, Cervera R. Diagnosis and classification of the antiphospholipid syndrome. J Autoimmun. 2014 Feb-Mar;48-49:20-5
5. Cervera R, Khamashta MA, Shoenfeld Y, Camps MT, Jacobsen S, Kiss E, et al. Morbidity and mortality in the antiphospholipid syndrome during a 5-year period: a multicentre prospective study of 1000 patients. Ann Rheum Dis. 2009 Sep;68(9):1428-32.
6. Wendelboe AM, Raskob GE. Global Burden of Thrombosis: Epidemiologic Aspects. Circ Res. 2016 Apr 29;118(9):1340-7.
7. Konstantinides SV, Meyer G, Becattini C, Bueno H, Geersing GJ, Harjola VP, et al. 2019 ESC Guidelines for the diagnosis and management of acute pulmonary embolism developed in collaboration with the European Respiratory Society (ERS). Eur Heart J. 2020;41(4):543-603.
8. Rodziewicz M, D'Cruz DP. An update on the management of antiphospholipid syndrome. Ther Adv Musculoskelet Dis. 2020;12:1759720X20910855.
9. Miyakis S, Lockshin MD, Atsumi T, Branch DW, Brey RL, Cervera R, et al. International consensus statement on an update of the classification criteria for definite antiphospholipid syndrome (APS). J Thromb Haemost. 2006 Feb;4(2):295-306.
10. Garcia D, Erkan D. Diagnosis and Management of the Antiphospholipid Syndrome. N Engl J Med. 2018;378(21):2010-2021.
11. Lyhne MD, Kline JA, Nielsen-Kudsk JE, Andersen A. Pulmonary vasodilation in acute pulmonary embolism - a systematic review. Pulm Circ. 2020;10(1):2045894019899775.
12. BÄ•lohlávek J, Dytrych V, Linhart A. Pulmonary embolism, part I: Epidemiology, risk factors and risk stratification, pathophysiology, clinical presentation, diagnosis and nonthrombotic pulmonary embolism. Exp Clin Cardiol. 2013;18(2):129-138.
13. Gerges C, Skoro-Sajer N, Lang IM. Right ventricle in acute and chronic pulmonary embolism (2013 Grover Conference series). Pulm Circ. 2014;4(3):378-386.
14. Yamamoto T. Management of patients with high-risk pulmonary embolism: a narrative review. J Intensive Care. 2018;6:16.
15. Guo DJ, Zhao C, Zou YD, Huang XH, Hu JM, Guo L. Values of the Wells and revised Geneva scores combined with D-dimer in diagnosing elderly pulmonary embolism patients. Chin Med J (Engl). 2015;128(8):1052-1057.
16. Penaloza A, Soulié C, Moumneh T, Delmez Q, Ghuysen A, Kouri DE, et al. Pulmonary embolism rule-out criteria (PERC) rule in European patients with low implicit clinical probability (PERCEPIC): a multicentre, prospective, observational study. Lancet Haematol. 2017 Dec;4(12):e615-e621
17. Moore AJE, Wachsmann J, Chamarthy MR, Panjikaran L, Tanabe Y, Rajiah P. Imaging of acute pulmonary embolism: an update. Cardiovasc Diagn Ther. 2018;8(3):225-243.
18. Dufrost V, Risse J, Zuily S, Wahl D. Direct Oral Anticoagulants Use in Antiphospholipid Syndrome: Are These Drugs an Effective and Safe Alternative to Warfarin? A Systematic Review of the Literature. Curr Rheumatol Rep. 2016;18(12):74
19. Pengo V, Hoxha A, Andreoli L, Tincani A, Silvestri E, Prisco D, et al. Trial of Rivaroxaban in AntiPhospholipid Syndrome (TRAPS): Two-year outcomes after the study closure. J Thromb Haemost. 2021;19(2):531-535.
References
1. Morrone D, Morrone V. Acute Pulmonary Embolism: Focus on the Clinical Picture. Korean Circ J. 2018;48(5):365-381.
2. Turetz M, Sideris AT, Friedman OA, Triphathi N, Horowitz JM. Epidemiology, Pathophysiology, and Natural History of Pulmonary Embolism. Semin Intervent Radiol. 2018;35(2):92-98.
3. Na YS, Jang S, Hong S, Oh YM, Lee SD, Lee JS. Clinical Phenotype of a First Unprovoked Acute Pulmonary Embolism Associated with Antiphospholipid Antibody Syndrome. Tuberc Respir Dis (Seoul). 2019;82(1):53-61.
4. Gómez-Puerta JA, Cervera R. Diagnosis and classification of the antiphospholipid syndrome. J Autoimmun. 2014 Feb-Mar;48-49:20-5
5. Cervera R, Khamashta MA, Shoenfeld Y, Camps MT, Jacobsen S, Kiss E, et al. Morbidity and mortality in the antiphospholipid syndrome during a 5-year period: a multicentre prospective study of 1000 patients. Ann Rheum Dis. 2009 Sep;68(9):1428-32.
6. Wendelboe AM, Raskob GE. Global Burden of Thrombosis: Epidemiologic Aspects. Circ Res. 2016 Apr 29;118(9):1340-7.
7. Konstantinides SV, Meyer G, Becattini C, Bueno H, Geersing GJ, Harjola VP, et al. 2019 ESC Guidelines for the diagnosis and management of acute pulmonary embolism developed in collaboration with the European Respiratory Society (ERS). Eur Heart J. 2020;41(4):543-603.
8. Rodziewicz M, D'Cruz DP. An update on the management of antiphospholipid syndrome. Ther Adv Musculoskelet Dis. 2020;12:1759720X20910855.
9. Miyakis S, Lockshin MD, Atsumi T, Branch DW, Brey RL, Cervera R, et al. International consensus statement on an update of the classification criteria for definite antiphospholipid syndrome (APS). J Thromb Haemost. 2006 Feb;4(2):295-306.
10. Garcia D, Erkan D. Diagnosis and Management of the Antiphospholipid Syndrome. N Engl J Med. 2018;378(21):2010-2021.
11. Lyhne MD, Kline JA, Nielsen-Kudsk JE, Andersen A. Pulmonary vasodilation in acute pulmonary embolism - a systematic review. Pulm Circ. 2020;10(1):2045894019899775.
12. BÄ•lohlávek J, Dytrych V, Linhart A. Pulmonary embolism, part I: Epidemiology, risk factors and risk stratification, pathophysiology, clinical presentation, diagnosis and nonthrombotic pulmonary embolism. Exp Clin Cardiol. 2013;18(2):129-138.
13. Gerges C, Skoro-Sajer N, Lang IM. Right ventricle in acute and chronic pulmonary embolism (2013 Grover Conference series). Pulm Circ. 2014;4(3):378-386.
14. Yamamoto T. Management of patients with high-risk pulmonary embolism: a narrative review. J Intensive Care. 2018;6:16.
15. Guo DJ, Zhao C, Zou YD, Huang XH, Hu JM, Guo L. Values of the Wells and revised Geneva scores combined with D-dimer in diagnosing elderly pulmonary embolism patients. Chin Med J (Engl). 2015;128(8):1052-1057.
16. Penaloza A, Soulié C, Moumneh T, Delmez Q, Ghuysen A, Kouri DE, et al. Pulmonary embolism rule-out criteria (PERC) rule in European patients with low implicit clinical probability (PERCEPIC): a multicentre, prospective, observational study. Lancet Haematol. 2017 Dec;4(12):e615-e621
17. Moore AJE, Wachsmann J, Chamarthy MR, Panjikaran L, Tanabe Y, Rajiah P. Imaging of acute pulmonary embolism: an update. Cardiovasc Diagn Ther. 2018;8(3):225-243.
18. Dufrost V, Risse J, Zuily S, Wahl D. Direct Oral Anticoagulants Use in Antiphospholipid Syndrome: Are These Drugs an Effective and Safe Alternative to Warfarin? A Systematic Review of the Literature. Curr Rheumatol Rep. 2016;18(12):74
19. Pengo V, Hoxha A, Andreoli L, Tincani A, Silvestri E, Prisco D, et al. Trial of Rivaroxaban in AntiPhospholipid Syndrome (TRAPS): Two-year outcomes after the study closure. J Thromb Haemost. 2021;19(2):531-535.
2. Turetz M, Sideris AT, Friedman OA, Triphathi N, Horowitz JM. Epidemiology, Pathophysiology, and Natural History of Pulmonary Embolism. Semin Intervent Radiol. 2018;35(2):92-98.
3. Na YS, Jang S, Hong S, Oh YM, Lee SD, Lee JS. Clinical Phenotype of a First Unprovoked Acute Pulmonary Embolism Associated with Antiphospholipid Antibody Syndrome. Tuberc Respir Dis (Seoul). 2019;82(1):53-61.
4. Gómez-Puerta JA, Cervera R. Diagnosis and classification of the antiphospholipid syndrome. J Autoimmun. 2014 Feb-Mar;48-49:20-5
5. Cervera R, Khamashta MA, Shoenfeld Y, Camps MT, Jacobsen S, Kiss E, et al. Morbidity and mortality in the antiphospholipid syndrome during a 5-year period: a multicentre prospective study of 1000 patients. Ann Rheum Dis. 2009 Sep;68(9):1428-32.
6. Wendelboe AM, Raskob GE. Global Burden of Thrombosis: Epidemiologic Aspects. Circ Res. 2016 Apr 29;118(9):1340-7.
7. Konstantinides SV, Meyer G, Becattini C, Bueno H, Geersing GJ, Harjola VP, et al. 2019 ESC Guidelines for the diagnosis and management of acute pulmonary embolism developed in collaboration with the European Respiratory Society (ERS). Eur Heart J. 2020;41(4):543-603.
8. Rodziewicz M, D'Cruz DP. An update on the management of antiphospholipid syndrome. Ther Adv Musculoskelet Dis. 2020;12:1759720X20910855.
9. Miyakis S, Lockshin MD, Atsumi T, Branch DW, Brey RL, Cervera R, et al. International consensus statement on an update of the classification criteria for definite antiphospholipid syndrome (APS). J Thromb Haemost. 2006 Feb;4(2):295-306.
10. Garcia D, Erkan D. Diagnosis and Management of the Antiphospholipid Syndrome. N Engl J Med. 2018;378(21):2010-2021.
11. Lyhne MD, Kline JA, Nielsen-Kudsk JE, Andersen A. Pulmonary vasodilation in acute pulmonary embolism - a systematic review. Pulm Circ. 2020;10(1):2045894019899775.
12. BÄ•lohlávek J, Dytrych V, Linhart A. Pulmonary embolism, part I: Epidemiology, risk factors and risk stratification, pathophysiology, clinical presentation, diagnosis and nonthrombotic pulmonary embolism. Exp Clin Cardiol. 2013;18(2):129-138.
13. Gerges C, Skoro-Sajer N, Lang IM. Right ventricle in acute and chronic pulmonary embolism (2013 Grover Conference series). Pulm Circ. 2014;4(3):378-386.
14. Yamamoto T. Management of patients with high-risk pulmonary embolism: a narrative review. J Intensive Care. 2018;6:16.
15. Guo DJ, Zhao C, Zou YD, Huang XH, Hu JM, Guo L. Values of the Wells and revised Geneva scores combined with D-dimer in diagnosing elderly pulmonary embolism patients. Chin Med J (Engl). 2015;128(8):1052-1057.
16. Penaloza A, Soulié C, Moumneh T, Delmez Q, Ghuysen A, Kouri DE, et al. Pulmonary embolism rule-out criteria (PERC) rule in European patients with low implicit clinical probability (PERCEPIC): a multicentre, prospective, observational study. Lancet Haematol. 2017 Dec;4(12):e615-e621
17. Moore AJE, Wachsmann J, Chamarthy MR, Panjikaran L, Tanabe Y, Rajiah P. Imaging of acute pulmonary embolism: an update. Cardiovasc Diagn Ther. 2018;8(3):225-243.
18. Dufrost V, Risse J, Zuily S, Wahl D. Direct Oral Anticoagulants Use in Antiphospholipid Syndrome: Are These Drugs an Effective and Safe Alternative to Warfarin? A Systematic Review of the Literature. Curr Rheumatol Rep. 2016;18(12):74
19. Pengo V, Hoxha A, Andreoli L, Tincani A, Silvestri E, Prisco D, et al. Trial of Rivaroxaban in AntiPhospholipid Syndrome (TRAPS): Two-year outcomes after the study closure. J Thromb Haemost. 2021;19(2):531-535.