The risk-benefit balance of anticoagulant treatment: case report

Abstract

A 76-year-old female presents at the emergency department with dyspnea and pleuritic, sharp right laterothoracic pain that started suddenly. Her medical history includes stage 2 hypertension, diabetes mellitus type 2, chronic obstructive pulmonary disease stage IV GOLD with home oxygen therapy, chronic pulmonary heart disease, diffuse interstitial lung disease with a previous episode of alveolar hemorrhage, chronic renal disease stage 2, and paroxysmal atrial fibrillation, for which she had a Watchman device implanted, taking into consideration her anticoagulation contraindication due to the previous alveolar hemorrhage episode. The biological findings reveal hypoxemia and hypocapnia, a positive D-dimer test, an inflammatory syndrome, mild hypopotassemia, acute decompensation of chronic renal disease, and a positive urine culture with Enterococcus faecium. Emergency thoracic computed tomography reveals bilateral pulmonary thromboembolism. Immediate parenteral anticoagulation and antibiotic therapy are initiated with favorable evolution. At discharge, concerning the risk-benefit balance of anticoagulation in a senior patient with multiple comorbidities, the anticoagulant therapy is changed to a novel oral anticoagulant for at least three months, with reevaluation needed after that period.