Case 5
An 11-year-old Caucasian female with trisomy 21 (BMI 34.7 kg/m2), hypothyroidism on thyroid hormone replacement therapy, required placement of a etonogestrel implant in addition to COC (norgestimate 0.25 mg - ethinyl estradiol 35 mcg) for the management of menorrhagia. Ten months after initiation of hormonal therapy, patient presented with sudden onset of right leg swelling and pain. Ultrasound Doppler evaluation revealed extensive thrombosis throughout the right common femoral vein, femoral vein and upper popliteal vein (Figure 5). Unfractionated heparin was initiated. Due to patient’s developmental delay and inability to keep her on strict bed rest during catheter directed thrombolysis it was decided to transitioned patient to Apixaban. Patient showed clinical and radiological improvement one month following initiation of anticoagulation.