leuprolide and Thrombosis

A 35-year-old woman with a previously repaired atrial septal defect was referred for preoperative evaluation before laparoscopic surgery. The patient was asymptomatic, and a transesophageal echocardiographic examination revealed a probable thrombus attached to the tricuspid valve. The patient's history included therapy with a gonadotropin-releasing hormone analogue and deep venous thrombosis five months earlier. The tricuspid valve thrombus disappeared after anticoagulant therapy. Warfarin was initiated for prophylaxis. During the follow-up, the patient was event-free during laparoscopic surgery and pregnancy (when warfarin was switched to acetylsalicylic acid) and gave birth to a healthy term baby. Because etiological investigations revealed no reason for the tricuspid valve thrombus, it was considered to be related to the procoagulant state induced by hormonal treatment. The patient was scheduled for close follow-up.

Topics: Adult; Echocardiography, Transesophageal; Female; Fertility Agents, Female; Gonadotropin-Releasing Hormone; Humans; Leuprolide; Thrombosis; Tricuspid Valve

Subclinical and clinical thrombosis of bioprosthetic cardiac valves is more common than has been previously recognized. We present a unique case of acute thrombosis of a bioprosthetic mitral valve in a 40-year-old female patient undergoing hormonal stimulation as part of in vitro fertilization therapy, who also had concomitant protein C deficiency that was undiagnosed at the time. To the best of our knowledge, this is the first reported case of acute bioprosthetic valve thrombosis in this complex thrombophilic milieu, and suggests the need for increased screening for prothrombotic risk factors in female patients with bioprosthetic valves before they commence gonadotropin stimulation therapy.

Topics: Acute Disease; Adult; Bioprosthesis; Female; Fertility Agents, Female; Fertilization in Vitro; Heart Valve Diseases; Heart Valve Prosthesis; Humans; Leuprolide; Mitral Valve; Protein C Deficiency; Reoperation; Risk Factors; Thrombosis

Diverse complications have been reported in association with the growth and medical treatment of uterine leiomyomata. Infarction and necrosis may be common and incite complications from parasitic vascular attachment, pain and thrombosis. The rarity of severe complications in this situation warrants presentation of the following unique association.. A 33-year-old female, gravida 1, para 1, was treated with gonadotropin-releasing hormone agonist (GnRH-a) for three months prior to laparotomy and removal of a solitary, 5,190-g, pedunculated myoma. The mass had secured an additional vascular supply from the transverse colon and omentum. Although the immediate postoperative course was uncomplicated, delayed onset of abdominal pain and fever lead to the diagnosis of superior mesenteric and portal vein thrombosis. Portal vein thrombosis responded to thrombolytic infusion into the superior mesenteric artery. Superior mesenteric vein thrombosis persisted, with evidence of early vascular recanalization. After six weeks of additional anticoagulation, assessment by computed tomographic scan showed complete resolution of all thrombi.. While thrombosis has been reported with GnRH-a therapy in men with prostate cancer, its association with treatment in this benign case may have been a consequence of the massive tumor size. Steroid hormone deprivation potentially contributed to neovascularization and bowel involvement.

Topics: Adult; Anticoagulants; Delayed-Action Preparations; Female; Humans; Leiomyoma; Leuprolide; Mesenteric Veins; Portal Vein; Thrombosis; Uterine Neoplasms