A 15-year-old female with Tourette syndrome presented with left leg pain and swelling. In the month prior, she had increasing tics that made walking difficult for 3 weeks. Five days before she presented, she first noticed pain in her upper left thigh followed by the development of swelling and discoloration of her left leg. She had worsening pain, which made it difficult to ambulate, so she presented to the emergency room.

She had an ultrasound, which showed an occlusive thrombus of the left common femoral vein to the left popliteal vein.

Upon admission to the hematology team for initiation of anticoagulation, vitals were stable with weight at the 85th percentile. She was taking oral contraceptives, clonidine, and fluoxetine. She was discharged on rivaroxaban.

Three months later, she presented with left arm swelling and pain and was found to have nonocclusive LIJ thrombus. She was admitted again to transition anticoagulation to low molecular weight heparin.

Due to the development of a second deep vein thrombosis while on anticoagulation, our patient underwent a hypercoagulable evaluation. Which test is often inaccurate after initiating anticoagulation?

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Alexandra Prosser, MD; Lauren Amos, MD
Division of Pediatric Hematology Oncology & BMT
Children’s Mercy Hospital
Kansas City, MO, USA

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Categories: Case Quiz