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.