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Hypercoagulable State Due to Alcohol-Paracetamol Syndrome Producing Acute Limb Ischemia

Department of Vascular Surgery, "Red Cross" Hospital, Athens, Greece, konmoulakakis{at}yahoo.gr

Giorgos Sfyroeras, MD

Department of Vascular Surgery, "Red Cross" Hospital, Athens, Greece

Polivios Pavlidis, MD

Department of Vascular Surgery, "Red Cross" Hospital, Athens, Greece

Nikolaos Besias, MD

Department of Vascular Surgery, "Red Cross" Hospital, Athens, Greece

Dimitrios Maras, MD

Department of Vascular Surgery, "Red Cross" Hospital, Athens, Greece

Vassilios Andrikopoulos, MD, PhD

Department of Vascular Surgery, "Red Cross" Hospital, Athens, Greece

The authors describe a man with alcohol-paracetamol syndrome and hepatic failure who presented with acute arterial thrombosis of the left limb. The patient has jaundice, increased serum transaminase levels, and significant coagulopathy, with elevated international normalized ratio and prolonged prothrombin time. A transient hypercoagulable state due to liver failure is documented, characterized by acquired deficiencies of antithrombin III, protein C, and protein S. Laboratory and molecular testing for inherited hypercoagulable disorders during the follow-up period is positive for increased levels of factor VIII. The patient undergoes successful thrombectomy and receives intensive symptomatic and causal treatment, resulting in complete recovery. The patient is discharged 20 days after admission on a regimen of acenocoumarol.

Key Words: alcohol-paracetamol syndrome • acetaminophen toxicity • acquired deficiency • antithrombin III • protein C • protein S • factor VIII

Vascular and Endovascular Surgery, Vol. 41, No. 4, 362-365 (2007)
DOI: 10.1177/1538574407302731


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