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The Journal of the American Board of Family Practice 16:246-250 (2003)
© 2003 American Board of Family Practice

Medical Practice

When Deep Venous Thrombosis Fails to Respond to Therapy

Dawn LaPorte, MS, Sharon Farber, MD, Sergei Sorin, MD, Sara Wahba, MD, Elizabeth Daneels, DO, Adam Korzenko, MS and Colin P. Kopes-Kerr, MD, JD, MPH

From the Department of Family Medicine (DL, SF, SS, SW, ED, AK, CPK), State University of New York at Stony Brook

Correspondence: Address reprint requests to Colin P Kopes-Kerr, MD, University Hospital Department of Family Medicine, HSC L-4, 050, Stony Brook, NY 11794

Background: Deep venous thrombosis in primary care is usually treated with rest, analgesics, intravenous or low-molecular-weight heparin, and coumadin. In some cases, however, a less familiar course of diagnosis and management is required.

Methods: We describe the case of a 53-year-old truck driver who had an acute deep venous thrombosis of his right lower extremity, which failed to respond to routine therapy with heparin and warfarin. A literature search was undertaken to research the differential diagnosis and management of deep venous thrombosis and to review specifically the role of venal caval filters and inherited thrombotic disorders and occult cancer in this context.

Results and Conclusion: The ultimate diagnosis in our patient appeared to be signet ring cell cancer of the colon that had metastasized to the right thigh. This case is an example of the inherent limitations of even an aggressive diagnostic and therapeutic approach to the entity of refractory deep venous thrombosis.






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Copyright © 2003 by the American Board of Family Medicine.