Portal Vein Thrombosis in a Woman with a Large Uterine Fibroma
,
Abstract
This article presents a case of portal vein thrombosis accompanied by a large uterine fibroma. A 37-year-old virgin woman presented with vaginal bleeding, abdominal mass, fever, dyspnea and lower limbs edema. In past medical history, she did not have any systemic diseases. She had menometrorrhagia from four years ago. She was admitted with diagnosis of a large uterine fibroma and was suspected of COVID 19 pneumonia or thrombophlebitis. The final diagnosis was a large uterine fibroma with chronic portal vein thrombosis. Although uterine fibromas are benign tumors, they may make serious life-threatening complications like thrombosis. The cause of thrombosis is the pressure effect of fibroma and/ or transfusion to treat anemia. Although there may be other unknown etiologies for thrombosis in these patients. We suggest that existence of a large uterine myomas should be known as a risk factor for thrombosis ( like IBS, Covid 19 and etc.) and be given a score in Caprini Score system, to start anticoagulation before and after any surgical intervention.
1. Parker WH. Uterine fibroids in: Berek JS. Berek & Novak’s Gyenecology. 16th ed. Wolters Kluwer. 2020.
2. Stanko CM, Severson MA, 2nd, Molpus KL. Deep venous thrombosis associated with large leiomyomata uteri. A case report. J Reprod Med. 2001;46(4):405-7. PMID: 11354847
3. Sheikh HH. Uterine leiomyoma as a rare cause of acute abdomen and intestinal gangrene. Am J Obstet Gynecol. 1998;179(3 Pt 1):830-1. https://doi.org/10.1016/S0002-9378(98)70097-3
4. Falcone M, Serra P. Massive pulmonary embolism in a woman with leiomyomatous uterus causing pelvic deep venous thrombosis. Ann Ital Med Int. 2005;20(2):104-7.
5. Srettabunjong S. Systemic thromboembolism after deep vein thrombosis caused by uterine myomas. Am J Forensic Med Pathol. 2013;34(3):207-9. https://doi.org/10.1097/ PAF.0b013e318298a456
6. Hawes J, Lohr J, Blum B, Bhati A, Bhaskaran J, Engel A. Large uterine fibroids causing mechanical obstruction of the inferior vena cava and subsequent thrombosis: a case report. Vasc Endovascular Surg. 2006;40(5):425-7. https://doi. org/10.1177/1538574406291333
7. Bonito M, Gulemì L, Basili R, Brunetti G, Roselli D. Thrombosis associated with a large uterine myoma: case report. Clin Exp Obstet Gynecol. 2007;34(3):188-9.
8. Khilanani R, Dandolu V. Extensive iliac vein thrombosis as a rare complication of a uterine leiomyoma: a case report. J Reprod Med. 2007;52(6):537-8.
9. Ippolito E, Buora A, Belcaro G, Alari G, Arpaia G, Ciammaichella G. Deep vein thrombosis and pulmonary embolism in a patient affected by uterine fibroids: clinical case. Panminerva Med. 2012;54(1 Suppl 4):97-9.
10. Fernandes FL, Dinardo CL, Terra-Filho M. Uterine myoma as a cause of iliac vein thrombosis and pulmonary embolism: common disease, rare complication. Respirol Case Rep. 2014;2(4):132-4. https://doi.org/10.1002/rcr2.79
10. Fernandes FL, Dinardo CL, Terra-Filho M. Uterine myoma as a cause of iliac vein thrombosis and pulmonary embolism: common disease, rare complication. Respirol Case Rep. 2014;2(4):132-4. https://doi.org/10.1002/rcr2.79
11. Liu B, Liu C, Guan H, Li Y, Song X, Shen K, et al. Intravenous leiomyomatosis with inferior vena cava and heart extension. J Vasc Surg. 2009;50(4):897-902. https://doi.org/10.1016/j. jvs.2009.04.037
12. Moniaga NC, Randall LM. Uterine leiomyomatosis with intracaval and intracardiac extension. Gynecol Oncol Case Rep. 2012;2(4):130-2. https://doi.org/10.1016/j.gynor.2012.08.003
13. Shiota M, Kotani Y, Umemoto M, Tobiume T, Tsuritani M, Shimaoka M, et al. Deep-vein thrombosis is associated with large uterine fibroids. Tohoku J Exp Med. 2011;224(2):87-9. https:// doi.org/10.1620/tjem.224.87
14. Cărbunaru A, Herlea, Ionescu M, Dumitraşcu T. Extensive Left Iliac Veins and Inferior Vena Cava Thrombosis Revealing a Giant Uterine Myoma. Rom J Intern Med. 2016;54(1):70-3. https://doi. org/10.1515/rjim-2016-0009
15. Riat R, Chowdary P, Mavrides E, Magos A, Gatt A. Is there an association between thrombosis and fibroids? A single centre experience and literature review. Int J Lab Hematol. 2013;35(1): e13-6. https://doi.org/10.1111/ijlh.12020
16. Devabhaktuni P, Gupta P, Bhupatiraju S, Puranam B, Abdul S. Uterine Fibromyoma and Intravascular Thrombosis-Eight Cases. Open Journal of Obstetrics and Gynecology. 2014; 04:197-207.
17. van Hylckama Vlieg, A., Helmerhorst, F.M., Vandenbroucke, J.P., Doggen, C.J.M. and Rosendaal, F.R. (2009) The Venous Thrombotic Risk of Oral Contraceptives, Effects of Oestrogen Dose and Progestogen Type: Result of the MEGA Case-Control Study. British Medical Journal, 339, b2921. 18. Simioni, P., Sanson, B.J., Prandoni, P., Tormene, D., Friederich, P.W., Girolami, B., Gavasso, S., Huisman, M.V., Buller, H.R., Wouter ten Cate, J., Girolami, A. and Prins, M.H. (1999) Department of Medical and Surgical Sciences, University Hospital of Padua, ltaly. Incidence of Venous Thromboembolism in Families with Inherited Thrombophilia. Thrombosis and Haemostasis, 81, 198- 202. https://doi.org/10.1055/s-0037-1614442
19. Stegeman, B.H., de Bastos, M., Rosendaal, F.R., van Hylckama Vlieg, A., Helmerhorst, F.M., Stijnen, T. and Dekkers, O.M. (2013) Different Combined Oral Contraceptives and the Risk of Venous Thrombosis: Systematic Review and Network Meta-Analysis. British Medical Journal, 347, f5298. https://doi.org/10.1136/ bmj.f5298
20. Lidegaard, J., Nielsen, L.H., Skovlund, C.W., Skjeldestad, F.E. and Løkkegaard, E. (2011) Risk of Venous Thrombo- embolism from Use of Oral Contraceptives Containing Different Progestogens and Oestrogen Doses: Danish Cohort Study, 2001-9. British Medical Journal, 343, d6423(1). https://doi.org/10.1136/bmj. d6423
21. Kuenen BC, Slee PH, Seldenrijk CA, Wagenaar SS. Intravenous leiomyomatosis complicated by Budd-Chiari syndrome. Postgrad Med J. 1996;72(853):686-8. https://doi.org/10.1136/ pgmj.72.853.686
22. Parthipun AA, Taylor J, Manyonda I, Belli AM. Does size really matter? Analysis of the effect of large fibroids and uterine volumes on complication rates of uterine artery embolisation. Cardiovasc Intervent Radiol. 2010;33(5):955-9. https://doi. org/10.1007/s00270-010-9842-x
23. Grant PJ, Greene MT, Chopra V, Bernstein SJ, Hofer TP, Flanders SA. Assessing the Caprini Score for Risk Assessment of Venous Thromboembolism in Hospitalized Medical Patients. Am J Med. 2016;129(5):528-35. https://doi.org/10.1016/j. amjmed.2015.10.027
24. Caprini JA. Thrombosis risk assessment as a guide to quality patient care. Dis Mon. 2005 Feb-Mar;51(2-3):70-8. PMID: 15900257. https://doi.org/10.1016/j.disamonth.2005.02.003
25. Caprini JA. Risk assessment as a guide to thrombosis prophylaxis. Curr Opin Pulm Med. 2010 Sep;16(5):448-52. PMID: 20592595. https://doi.org/10.1097/MCP.0b013e32833c3d3e
26. Stroud W, Whitworth JM, Miklic M, Schneider KE, Finan MA, Scalici J, Reed E, Bazzett-Matabele L, Straughn JM Jr, Rocconi RP. Validation of a venous thromboembolism risk assessment model in gynecologic oncology. Gynecol Oncol. 2014 Jul;134(1):160-3. Epub 2014 May 4. PMID: 24796634. https://doi.org/10.1016/j. ygyno.2014.04.051
27. Cassidy MR, Rosenkranz P, McAneny D. Reducing postoperative venous thromboembolism complications with a standardized risk-stratified prophylaxis protocol and mobilization program. J Am Coll Surg. 2014 Jun;218(6):1095-104. Epub 2014 Mar 2. PMID: 24768293. https://doi.org/10.1016/j.jamcollsurg.2013.12.061
28. Tsaplin S, Schastlivtsev I, Zhuravlev S, Barinov V, Lobastov K, Caprini JA. The original and modified Caprini score equally predicts venous thromboembolism in COVID-19 patients. J Vasc Surg Venous Lymphat Disord. 2021 Nov;9(6):1371-1381. e4. Epub 2021 Mar 17. PMID: 33744497; PMCID: PMC7965848.
29. The COVID-19 Sub-Committee of the American Venous Forum Considerations in prophylaxis and treatment of VTE in COVID-19 patients; 2020. Available at: https://www.veinforum.org/wp- content/uploads/2020/04/COVID-19-White-Paper-04-17-2020- FINAL-1.pdf
30. Bartlett MA, Mauck KF, Stephenson CR, Ganesh R, Daniels PR. Perioperative Venous Thromboembolism Prophylaxis. Mayo Clin Proc. 2020 Dec;95(12):2775-2798. PMID: 33276846. https://doi. org/10.1016/j.mayocp.2020.06.015
31. Yang SD, Liu H, Sun YP, Yang DL, Shen Y, Feng SQ, et al. Prevalence and risk factors of deep vein thrombosis in patients after spine surgery: a retrospective case-cohort study. Sci Rep. 2015; 5:11834. https://doi.org/10.1038/srep11834
32. Khorana AA, Francis CW, Blumberg N, Culakova E, Refaai MA, Lyman GH. Blood transfusions, thrombosis, and mortality in hospitalized patients with cancer. Arch Intern Med. 2008;168(21):2377-81. https://doi.org/10.1001/ archinte.168.21.2377
33. Zander AL, Olson EJ, Van Gent JM, Bandle J, Calvo RY, Shackford SR, et al. Does resuscitation with plasma increase the risk of venous thromboembolism? J Trauma Acute Care Surg. 2015;78(1):39-43; discussion -4. https://doi.org/10.1097/ TA.0000000000000480
34. Bates SM, Greer IA, Middeldorp S, Veenstra DL, Prabulos AM, Vandvik PO. VTE, thrombophilia, antithrombotic therapy, and pregnancy: Antithrombotic Therapy and Prevention of Thrombosis, 9th ed: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines. Chest. 2012;141(2 Suppl):e691S-e736S. https://doi.org/10.1378/chest.11-2300
35. Plessier A, Darwish-Murad S, Hernandez-Guerra M, Consigny Y, Fabris F, Trebicka J, Heller J, Morard I, Lasser L, Langlet P, Denninger MH, Vidaud D, Condat B, Hadengue A, Primignani M, Garcia-Pagan JC, Janssen HL, Valla D; European Network for Vascular Disorders of the Liver (EN-Vie). Acute portal vein thrombosis unrelated to cirrhosis: a prospective multicenter follow-up study. Hepatology. 2010 Jan;51(1):210-8. PMID: 19821530. https://doi.org/10.1002/hep.23259
36. Delgado MG, Seijo S, Yepes I, Achécar L, Catalina MV, García- Criado A, Abraldes JG, de la Peña J, Bañares R, Albillos A, Bosch J, García-Pagán JC. Efficacy and safety of anticoagulation on patients with cirrhosis and portal vein thrombosis. Clin Gastroenterol Hepatol. 2012 Jul;10(7):776-83. Epub 2012 Jan 28. PMID: 22289875. https://doi.org/10.1016/j.cgh.2012.01.012
37. Chen H, Turon F, Hernández-Gea V, Fuster J, Garcia-Criado A, Barrufet M, Darnell A, Fondevila C, Garcia-Valdecasas JC, Garcia-Pagán JC. Nontumoral portal vein thrombosis in patients awaiting liver transplantation. Liver Transpl. 2016 Mar;22(3):352- 65. PMID: 26684272. https://doi.org/10.1002/lt.24387
38. Young K, Wong R. Evaluation and management of acute and chronic portal vein thrombosis in patients with cirrhosis. Clin Liver Dis (Hoboken). 2018;10(6):152-156. Published 2018 Jan 2. https://doi.org/10.1002/cld.679
39. Cui SB, Shu RH, Yan SP, Wu H, Chen Y, Wang L, Zhu Q. Efficacy and safety of anticoagulation therapy with different doses of enoxaparin for portal vein thrombosis in cirrhotic patients with hepatitis B. Eur J Gastroenterol Hepatol. 2015 Aug;27(8):914-9. PMID: 25856686. https://doi.org/10.1097/MEG.0000000000000351
2. Stanko CM, Severson MA, 2nd, Molpus KL. Deep venous thrombosis associated with large leiomyomata uteri. A case report. J Reprod Med. 2001;46(4):405-7. PMID: 11354847
3. Sheikh HH. Uterine leiomyoma as a rare cause of acute abdomen and intestinal gangrene. Am J Obstet Gynecol. 1998;179(3 Pt 1):830-1. https://doi.org/10.1016/S0002-9378(98)70097-3
4. Falcone M, Serra P. Massive pulmonary embolism in a woman with leiomyomatous uterus causing pelvic deep venous thrombosis. Ann Ital Med Int. 2005;20(2):104-7.
5. Srettabunjong S. Systemic thromboembolism after deep vein thrombosis caused by uterine myomas. Am J Forensic Med Pathol. 2013;34(3):207-9. https://doi.org/10.1097/ PAF.0b013e318298a456
6. Hawes J, Lohr J, Blum B, Bhati A, Bhaskaran J, Engel A. Large uterine fibroids causing mechanical obstruction of the inferior vena cava and subsequent thrombosis: a case report. Vasc Endovascular Surg. 2006;40(5):425-7. https://doi. org/10.1177/1538574406291333
7. Bonito M, Gulemì L, Basili R, Brunetti G, Roselli D. Thrombosis associated with a large uterine myoma: case report. Clin Exp Obstet Gynecol. 2007;34(3):188-9.
8. Khilanani R, Dandolu V. Extensive iliac vein thrombosis as a rare complication of a uterine leiomyoma: a case report. J Reprod Med. 2007;52(6):537-8.
9. Ippolito E, Buora A, Belcaro G, Alari G, Arpaia G, Ciammaichella G. Deep vein thrombosis and pulmonary embolism in a patient affected by uterine fibroids: clinical case. Panminerva Med. 2012;54(1 Suppl 4):97-9.
10. Fernandes FL, Dinardo CL, Terra-Filho M. Uterine myoma as a cause of iliac vein thrombosis and pulmonary embolism: common disease, rare complication. Respirol Case Rep. 2014;2(4):132-4. https://doi.org/10.1002/rcr2.79
10. Fernandes FL, Dinardo CL, Terra-Filho M. Uterine myoma as a cause of iliac vein thrombosis and pulmonary embolism: common disease, rare complication. Respirol Case Rep. 2014;2(4):132-4. https://doi.org/10.1002/rcr2.79
11. Liu B, Liu C, Guan H, Li Y, Song X, Shen K, et al. Intravenous leiomyomatosis with inferior vena cava and heart extension. J Vasc Surg. 2009;50(4):897-902. https://doi.org/10.1016/j. jvs.2009.04.037
12. Moniaga NC, Randall LM. Uterine leiomyomatosis with intracaval and intracardiac extension. Gynecol Oncol Case Rep. 2012;2(4):130-2. https://doi.org/10.1016/j.gynor.2012.08.003
13. Shiota M, Kotani Y, Umemoto M, Tobiume T, Tsuritani M, Shimaoka M, et al. Deep-vein thrombosis is associated with large uterine fibroids. Tohoku J Exp Med. 2011;224(2):87-9. https:// doi.org/10.1620/tjem.224.87
14. Cărbunaru A, Herlea, Ionescu M, Dumitraşcu T. Extensive Left Iliac Veins and Inferior Vena Cava Thrombosis Revealing a Giant Uterine Myoma. Rom J Intern Med. 2016;54(1):70-3. https://doi. org/10.1515/rjim-2016-0009
15. Riat R, Chowdary P, Mavrides E, Magos A, Gatt A. Is there an association between thrombosis and fibroids? A single centre experience and literature review. Int J Lab Hematol. 2013;35(1): e13-6. https://doi.org/10.1111/ijlh.12020
16. Devabhaktuni P, Gupta P, Bhupatiraju S, Puranam B, Abdul S. Uterine Fibromyoma and Intravascular Thrombosis-Eight Cases. Open Journal of Obstetrics and Gynecology. 2014; 04:197-207.
17. van Hylckama Vlieg, A., Helmerhorst, F.M., Vandenbroucke, J.P., Doggen, C.J.M. and Rosendaal, F.R. (2009) The Venous Thrombotic Risk of Oral Contraceptives, Effects of Oestrogen Dose and Progestogen Type: Result of the MEGA Case-Control Study. British Medical Journal, 339, b2921. 18. Simioni, P., Sanson, B.J., Prandoni, P., Tormene, D., Friederich, P.W., Girolami, B., Gavasso, S., Huisman, M.V., Buller, H.R., Wouter ten Cate, J., Girolami, A. and Prins, M.H. (1999) Department of Medical and Surgical Sciences, University Hospital of Padua, ltaly. Incidence of Venous Thromboembolism in Families with Inherited Thrombophilia. Thrombosis and Haemostasis, 81, 198- 202. https://doi.org/10.1055/s-0037-1614442
19. Stegeman, B.H., de Bastos, M., Rosendaal, F.R., van Hylckama Vlieg, A., Helmerhorst, F.M., Stijnen, T. and Dekkers, O.M. (2013) Different Combined Oral Contraceptives and the Risk of Venous Thrombosis: Systematic Review and Network Meta-Analysis. British Medical Journal, 347, f5298. https://doi.org/10.1136/ bmj.f5298
20. Lidegaard, J., Nielsen, L.H., Skovlund, C.W., Skjeldestad, F.E. and Løkkegaard, E. (2011) Risk of Venous Thrombo- embolism from Use of Oral Contraceptives Containing Different Progestogens and Oestrogen Doses: Danish Cohort Study, 2001-9. British Medical Journal, 343, d6423(1). https://doi.org/10.1136/bmj. d6423
21. Kuenen BC, Slee PH, Seldenrijk CA, Wagenaar SS. Intravenous leiomyomatosis complicated by Budd-Chiari syndrome. Postgrad Med J. 1996;72(853):686-8. https://doi.org/10.1136/ pgmj.72.853.686
22. Parthipun AA, Taylor J, Manyonda I, Belli AM. Does size really matter? Analysis of the effect of large fibroids and uterine volumes on complication rates of uterine artery embolisation. Cardiovasc Intervent Radiol. 2010;33(5):955-9. https://doi. org/10.1007/s00270-010-9842-x
23. Grant PJ, Greene MT, Chopra V, Bernstein SJ, Hofer TP, Flanders SA. Assessing the Caprini Score for Risk Assessment of Venous Thromboembolism in Hospitalized Medical Patients. Am J Med. 2016;129(5):528-35. https://doi.org/10.1016/j. amjmed.2015.10.027
24. Caprini JA. Thrombosis risk assessment as a guide to quality patient care. Dis Mon. 2005 Feb-Mar;51(2-3):70-8. PMID: 15900257. https://doi.org/10.1016/j.disamonth.2005.02.003
25. Caprini JA. Risk assessment as a guide to thrombosis prophylaxis. Curr Opin Pulm Med. 2010 Sep;16(5):448-52. PMID: 20592595. https://doi.org/10.1097/MCP.0b013e32833c3d3e
26. Stroud W, Whitworth JM, Miklic M, Schneider KE, Finan MA, Scalici J, Reed E, Bazzett-Matabele L, Straughn JM Jr, Rocconi RP. Validation of a venous thromboembolism risk assessment model in gynecologic oncology. Gynecol Oncol. 2014 Jul;134(1):160-3. Epub 2014 May 4. PMID: 24796634. https://doi.org/10.1016/j. ygyno.2014.04.051
27. Cassidy MR, Rosenkranz P, McAneny D. Reducing postoperative venous thromboembolism complications with a standardized risk-stratified prophylaxis protocol and mobilization program. J Am Coll Surg. 2014 Jun;218(6):1095-104. Epub 2014 Mar 2. PMID: 24768293. https://doi.org/10.1016/j.jamcollsurg.2013.12.061
28. Tsaplin S, Schastlivtsev I, Zhuravlev S, Barinov V, Lobastov K, Caprini JA. The original and modified Caprini score equally predicts venous thromboembolism in COVID-19 patients. J Vasc Surg Venous Lymphat Disord. 2021 Nov;9(6):1371-1381. e4. Epub 2021 Mar 17. PMID: 33744497; PMCID: PMC7965848.
29. The COVID-19 Sub-Committee of the American Venous Forum Considerations in prophylaxis and treatment of VTE in COVID-19 patients; 2020. Available at: https://www.veinforum.org/wp- content/uploads/2020/04/COVID-19-White-Paper-04-17-2020- FINAL-1.pdf
30. Bartlett MA, Mauck KF, Stephenson CR, Ganesh R, Daniels PR. Perioperative Venous Thromboembolism Prophylaxis. Mayo Clin Proc. 2020 Dec;95(12):2775-2798. PMID: 33276846. https://doi. org/10.1016/j.mayocp.2020.06.015
31. Yang SD, Liu H, Sun YP, Yang DL, Shen Y, Feng SQ, et al. Prevalence and risk factors of deep vein thrombosis in patients after spine surgery: a retrospective case-cohort study. Sci Rep. 2015; 5:11834. https://doi.org/10.1038/srep11834
32. Khorana AA, Francis CW, Blumberg N, Culakova E, Refaai MA, Lyman GH. Blood transfusions, thrombosis, and mortality in hospitalized patients with cancer. Arch Intern Med. 2008;168(21):2377-81. https://doi.org/10.1001/ archinte.168.21.2377
33. Zander AL, Olson EJ, Van Gent JM, Bandle J, Calvo RY, Shackford SR, et al. Does resuscitation with plasma increase the risk of venous thromboembolism? J Trauma Acute Care Surg. 2015;78(1):39-43; discussion -4. https://doi.org/10.1097/ TA.0000000000000480
34. Bates SM, Greer IA, Middeldorp S, Veenstra DL, Prabulos AM, Vandvik PO. VTE, thrombophilia, antithrombotic therapy, and pregnancy: Antithrombotic Therapy and Prevention of Thrombosis, 9th ed: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines. Chest. 2012;141(2 Suppl):e691S-e736S. https://doi.org/10.1378/chest.11-2300
35. Plessier A, Darwish-Murad S, Hernandez-Guerra M, Consigny Y, Fabris F, Trebicka J, Heller J, Morard I, Lasser L, Langlet P, Denninger MH, Vidaud D, Condat B, Hadengue A, Primignani M, Garcia-Pagan JC, Janssen HL, Valla D; European Network for Vascular Disorders of the Liver (EN-Vie). Acute portal vein thrombosis unrelated to cirrhosis: a prospective multicenter follow-up study. Hepatology. 2010 Jan;51(1):210-8. PMID: 19821530. https://doi.org/10.1002/hep.23259
36. Delgado MG, Seijo S, Yepes I, Achécar L, Catalina MV, García- Criado A, Abraldes JG, de la Peña J, Bañares R, Albillos A, Bosch J, García-Pagán JC. Efficacy and safety of anticoagulation on patients with cirrhosis and portal vein thrombosis. Clin Gastroenterol Hepatol. 2012 Jul;10(7):776-83. Epub 2012 Jan 28. PMID: 22289875. https://doi.org/10.1016/j.cgh.2012.01.012
37. Chen H, Turon F, Hernández-Gea V, Fuster J, Garcia-Criado A, Barrufet M, Darnell A, Fondevila C, Garcia-Valdecasas JC, Garcia-Pagán JC. Nontumoral portal vein thrombosis in patients awaiting liver transplantation. Liver Transpl. 2016 Mar;22(3):352- 65. PMID: 26684272. https://doi.org/10.1002/lt.24387
38. Young K, Wong R. Evaluation and management of acute and chronic portal vein thrombosis in patients with cirrhosis. Clin Liver Dis (Hoboken). 2018;10(6):152-156. Published 2018 Jan 2. https://doi.org/10.1002/cld.679
39. Cui SB, Shu RH, Yan SP, Wu H, Chen Y, Wang L, Zhu Q. Efficacy and safety of anticoagulation therapy with different doses of enoxaparin for portal vein thrombosis in cirrhotic patients with hepatitis B. Eur J Gastroenterol Hepatol. 2015 Aug;27(8):914-9. PMID: 25856686. https://doi.org/10.1097/MEG.0000000000000351
| Files | ||
| Issue | Vol 7 No 6 (2022): November-December | |
| Section | Case Report(s) | |
| DOI | https://doi.org/10.18502/crcp.v7i6.12277 | |
| Keywords | ||
| Portal vein Thrombosis Uterine fibroma | ||
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How to Cite
1.
Almassinokiani F, Akbari P, Almassi Nokiani A, Sarchami N. Portal Vein Thrombosis in a Woman with a Large Uterine Fibroma. CRCP. 2023;7(6):306-312.
