ArticleJournal of medical case reports2026
Chromogenic factor X-guided warfarin monitoring in lupus anticoagulant-positive primary antiphospholipid syndrome with adrenal hemorrhage and progressive deep vein thrombosis: a case report.
Article in Journal of medical case reports, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
backgroundAntiphospholipid syndrome (APS) is a thrombotic autoimmune disorder; adrenal hemorrhage is uncommon. Treating progressive thrombosis with concurrent major bleeding is challenging, especially when lupus anticoagulant (LA) may compromise international normalized ratio (INR)-based warfarin monitoring. CASE PRESENTATION: A 32-year-old Chinese man had isolated marked activated partial thromboplastin time prolongation detected preoperatively 4 years earlier. He showed persistent LA positivity and high-titer anticardiolipin and anti-β2-glycoprotein I antibodies, but no thrombosis was documented and he was lost to follow-up. One year before the current admission, he developed extensive lower-limb deep vein thrombosis (DVT) after a left ankle sprain, followed days later by right-sided lower back/flank pain. Computed tomography showed right adrenal hemorrhage with adjacent perirenal extension. Anticoagulation was withheld because of bleeding, and an inferior vena cava filter was placed. He was readmitted 2 days later with worsening pain, progressive bilateral DVT, thrombocytopenia, markedly elevated D-dimer, and persistent triple-positive antiphospholipid antibodies. After multidisciplinary review, endovascular embolization was performed for local hemostatic control. Anticoagulation was then escalated from reduced-dose enoxaparin to therapeutic-dose enoxaparin, approximately 1 mg/kg every 12 h, and warfarin was initiated. Because LA raised concern regarding INR reliability, chromogenic factor X (CFX) activity was used to guide warfarin monitoring, with a target range of 20%-40%. At 6 months, imaging showed near-complete hematoma absorption and venous recanalization, without recurrent major bleeding or new thrombosis.
conclusionsIn selected LA-positive APS patients with competing risks of thrombosis and adrenal hemorrhage, endovascular hemostasis followed by cautious anticoagulation escalation and CFX-guided warfarin monitoring may be feasible when INR monitoring is potentially unreliable.
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