Abstract
The article presents a clinical case of a patient with an atypical combined cause of pulmonary embolism (PE), which resulted from activation of the blood coagulation system against the background of hereditary genetic polymorphism, hormonal contraceptives and COVID-19; in the absence of deep vein thrombosis, which is considered the main cause of the development of PE.
Materials and methods: physical research methods, the PE – Wells probability scale, general clinical laboratory parameters, D-dimer and homocysteine levels in blood plasma, coagulogram, PCR test for SARS-CoV-2 in a nasopharyngeal smear, electrocardiography, echocardiography, MSCT of the chest organs with intravenous contrast enhancement of the pulmonary artery. The genetic polymorphisms associated with the risk of hypercoagulation are analyzed. The example of this clinical case shows the combined effects of thrombosis factors as causes of PE (hereditary predisposition, overweight, hypertension, taking combined oral contraceptives, carrying polymorphisms of folate cycle genes, increased blood coagulation factor VIII, fibrinogen levels, hyperhomocysteinemia). These changes should be taken into account when prescribing treatment of acute PE and secondary prevention of venous thromboembolic complications. The identified risk factors need to be corrected and should be taken into account when choosing a method of contraception. The increased risk of thrombosis in COVID-19 conditions determines the need to expand the indications for the search for PE by all possible methods.
Keywords: pulmonary embolism, hypercoagulation, combined oral contraceptives, genetic polymorphism, hyperhomocysteinemia, COVID-19.
Materials and methods: physical research methods, the PE – Wells probability scale, general clinical laboratory parameters, D-dimer and homocysteine levels in blood plasma, coagulogram, PCR test for SARS-CoV-2 in a nasopharyngeal smear, electrocardiography, echocardiography, MSCT of the chest organs with intravenous contrast enhancement of the pulmonary artery. The genetic polymorphisms associated with the risk of hypercoagulation are analyzed. The example of this clinical case shows the combined effects of thrombosis factors as causes of PE (hereditary predisposition, overweight, hypertension, taking combined oral contraceptives, carrying polymorphisms of folate cycle genes, increased blood coagulation factor VIII, fibrinogen levels, hyperhomocysteinemia). These changes should be taken into account when prescribing treatment of acute PE and secondary prevention of venous thromboembolic complications. The identified risk factors need to be corrected and should be taken into account when choosing a method of contraception. The increased risk of thrombosis in COVID-19 conditions determines the need to expand the indications for the search for PE by all possible methods.
Keywords: pulmonary embolism, hypercoagulation, combined oral contraceptives, genetic polymorphism, hyperhomocysteinemia, COVID-19.
For citation:Zamahina O.V., Slepcova J.O., Usacheva E.V., Sultan-Muratova E.G. A clinical case of pulmonary embolism against the background of activation of the blood coagulation system. Clinical review for general practice. 2024; 5 (10): 19–24 (In Russ.). DOI: 10.47407/kr2024. 5.11.00512
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