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Background <p>Venous thromboembolism is a leading cause of maternal morbidity and mortality in the postpartum period. Physiological hypercoagulability during pregnancy, combined with inherited thrombophilia and treatment-related complications, may contribute to severe thrombotic events.</p> Case Presentation <p>A 24-year-old woman presented ten days after vaginal delivery with left leg swelling and cyanosis. Doppler ultrasonography revealed left iliofemoral thrombosis, with the upper level at the border of the external iliac vein and upper third of the common iliac vein. Unfractionated heparin (UFH) was initiated with clinical improvement. After two days, therapy was switched to low-molecular-weight heparin (LMWH; dalteparin) with therapeutic anti-Xa level (0.95 IU/mL). Two days later, the platelet count dropped to 39 × 10⁹/L, confirming heparin-induced thrombocytopenia (HIT). Repeat ultrasonography demonstrated thrombosis progression with new right leg involvement. Heparin was discontinued and fondaparinux initiated; however, further progression to inferior vena cava thrombosis occurred. Computed tomography angiography revealed bilateral submassive pulmonary embolism (50–70% involvement). Thrombophilia testing showed protein C deficiency (52%). Fourteen days after symptom onset, rivaroxaban was initiated, leading to gradual improvement and complete thrombus resolution at six months.</p> Conclusion <p>This case highlights the convergence of postpartum hypercoagulability, protein C deficiency, and HIT. Prompt diagnosis, and timely transition to non- heparin anticoagulation are essential for successful management.</p>

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Postpartum Iliocaval Thrombosis, Complicated with Submassive Pulmonary Embolism and Heparin-Induced Thrombocytopenia in a Patient with Protein C deficiency: A Case Report

  • 期刊论文

  • 发表日期：

    2026年6月1日

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  • Khvoryk Natallia,
  • K. A. Nethuki Kulasinghe

摘要

Background

Venous thromboembolism is a leading cause of maternal morbidity and mortality in the postpartum period. Physiological hypercoagulability during pregnancy, combined with inherited thrombophilia and treatment-related complications, may contribute to severe thrombotic events.

Case Presentation

A 24-year-old woman presented ten days after vaginal delivery with left leg swelling and cyanosis. Doppler ultrasonography revealed left iliofemoral thrombosis, with the upper level at the border of the external iliac vein and upper third of the common iliac vein. Unfractionated heparin (UFH) was initiated with clinical improvement. After two days, therapy was switched to low-molecular-weight heparin (LMWH; dalteparin) with therapeutic anti-Xa level (0.95 IU/mL). Two days later, the platelet count dropped to 39 × 10⁹/L, confirming heparin-induced thrombocytopenia (HIT). Repeat ultrasonography demonstrated thrombosis progression with new right leg involvement. Heparin was discontinued and fondaparinux initiated; however, further progression to inferior vena cava thrombosis occurred. Computed tomography angiography revealed bilateral submassive pulmonary embolism (50–70% involvement). Thrombophilia testing showed protein C deficiency (52%). Fourteen days after symptom onset, rivaroxaban was initiated, leading to gradual improvement and complete thrombus resolution at six months.

Conclusion

This case highlights the convergence of postpartum hypercoagulability, protein C deficiency, and HIT. Prompt diagnosis, and timely transition to non- heparin anticoagulation are essential for successful management.