Case 102 – Update 1.

Thanks for everyones contributions!

Following everyone’s suggestions we now know that this 29 year old with an extensive upper limb DVT, has been short of breath over the past few weeks and non-specifically unwell. She has been on the combined oral contraceptive pill for 2 years and rarely misses any doses. She has had no other recent relevant personal history including no venous catheters, surgeries and does not undergo excessive exercise regimes. She has no relevant family history.

She has been commenced on therapeutic anticoagulation. An antiphospholipid screen and CTPA (to assess for both PE and an accessory rib) are pending.

Questions:

  1. What risk would you attribute to the COCP and thrombosis?
  2. What would you advise about the use of OCP to this lady now?
  3. If this appears to be idiopathic upper limb DVT with no other known risk factors how would you manage?

Join us on Twitter @TeamHaem and let us know what your thoughts are, what questions you have and what you want to do as we see this case evolve over the next week.

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