Venous thromboembolism in anorexia nervosa: four cases from a specialized unit. Indication for thromboprophylaxis?
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CASE REPORT
Venous thromboembolism in anorexia nervosa: four cases from a specialized unit. Indication for thromboprophylaxis? Zainab Abdelhadi1 · Else Marie Bladbjerg2,3 · Dorte Møller Jensen4,5,6 · Amalie Schousboe7 · René Klinkby Støving1,7,8,9 Received: 20 August 2019 / Accepted: 7 December 2019 © Springer Nature Switzerland AG 2019
Abstract Background Venous thromboembolism (VTE), which includes deep vein thrombosis (DVT) and pulmonary embolism (PE), is a major cause of mortality and morbidity. VTE may occur asymptomatic or subclinical. Fluid retention during intensive re-nutrition or rapid weight changes are well-known phenomena in anorexia nervosa (AN) and may represent a significant risk factor for VTE. Objective The incidence of VTE in patients with AN is unknown, and the conditions may be overlooked in a complex clinical picture. Method This study report four cases of VTE in women with severe AN (age range 19–41 years, BMI range 10.6–13.1) admitted to a specialized unit for medical stabilization. Results DVT or PE was diagnosed in all four patients. The patients were admitted for intensive re-nutrition according to conventional conservative guidelines with slow increase in energy supply (start low and advance slow). Due to suspected VTE, thromboprophylaxis was given during hospitalization, three of whom were undergoing re-nutrition. Conclusion The four presented cases suggest that VTE during re-nutrition in AN may be an overlooked risk which may not be sufficiently addressed in the literature. General recommendations should not be issued on the basis of case reports; however, we want to raise awareness and call for studies to identify the VTE risk and appropriate thromboprophylaxis in AN patients. Keywords Anorexia nervosa · Venous thromboembolism · Deep vein thrombosis · Pulmonary embolism · Refeeding syndrome
Introduction Sudden unexpected death is a rare but a well-known complication in patients with anorexia nervosa (AN), and cardiac arrest due to fluid and electrolyte disturbances is a recognized cause. However, in the literature, the cause of death * René Klinkby Støving [email protected] 1
Center for Eating Disorders, Odense University Hospital, Odense, Denmark
Unit for Thrombosis Research, Department of Regional Health Research, The University of Southern Denmark, Odense, Denmark
2
3
4
Department of Clinical Biochemistry, Hospital of South West Jutland, Esbjerg, Denmark Steno Diabetes Center Odense, Odense University Hospital, Odense, Denmark
is rarely examined by autopsy. The recorded cause of death may be inaccurate, such as “cardiac arrest”, “cachexia”, or “weakness” [1]. To our knowledge, only one single case report describes autopsy findings, and here pulmonary embolism (PE) was found in a 36-year-old woman with BMI 12.5 kg/m2 and no clinical signs of PE [2]. 5
Department of Gynecology and Obstetrics, Odense University Hospital, Odense, Denmark
6
Department of Clinical Science, University of Southern Denmark, Odense, Denmark
7
Elite Resea
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