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Abstract: Based on different mechanisms of blood coagulation, coexistence of venous thromboembolism and arterial thrombosis in a single individual is extremely rare in clinical practice. Both antiplatelet and anticoagulation therapy should be adopted for patients with arteriovenous embolism. Balancing the risk of ischemia and hemorrhage is especially challenging in these patients in order to achieve an optimal clinical benefit. We report on a 55-year-old female with acute pulmonary embolism (PE), subsequently diagnosed as having acute myocardial infarction (AMI) and a cerebral infarction. Examinations had been carried out, excluding potential arteriovenous shunts, cancer, antiphospholipid syndrome and other common hypercoagulable states. A combination of an anticoagulant drug (rivaroxaban, an Xa inhibitor) and an antiplatelet agent (clopidogrel, an ADP receptor inhibitor) was prescribed with a β-blocker and atorvastatin. The embolus was gradually shrunk during the next 10 months, and then it turned back into expanding. During the 16 months’ follow-up, an aneurysm of left ventricular apex was found through an echocardiogram and an angiotensin-converting enzyme inhibitor was administered. We conclude that combined anticoagulation and antiplatelet therapy significantly relieved the symptoms and improved the prognosis in patients suffering from arteriovenous embolism without any major clinical bleeding events.

肺栓塞合并体循环栓塞的个案报道

研究目的：通过一例罕见肺栓塞合并体循环栓塞病例报道及定期随访，为临床诊断思路和合理治疗方案的制定提供依据。
研究方法：本文报道一例在急诊室发生急性肺动脉栓塞，后继又出现急性心肌梗死和脑梗塞的病例。患者住院期间接受了严密监护并排除各种病因，出院后随访16个月，动态观察肺动脉栓塞病情的进展和心脏重构的过程（如图3）。结果显示，早期溶栓治疗，合理进行抗凝和抗血小板为主的综合治疗能显著缓解患者症状，改善生活质量和预后。
重要结论：临床上动静脉系统同时发生栓塞虽然比较罕见，但仍需提高警惕并及早诊断，早期进行合理的治疗。抗凝和抗血小板为主的联合治疗能显著改善症状，提高患者生活质量，改善预后。
肺栓塞；脑梗塞；急性心肌梗死；室壁瘤

[1] Dewilde, W.J., Oirbans, T., Verheugt, F.W., 2013. Use of clopidogrel with or without aspirin in patients taking oral anticoagulant therapy and undergoing percutaneous coronary intervention: an open-label, randomised, controlled trial. Lancet, 381(9872):1107-1115. 

[2] Goldhaber, S.Z., 2005. Pulmonary thromboembolism.  Harrisons Principles of Internal Medicine. McGraw-Hill,New York :1561-1565. 

[3] Kumar, V., 2010.  Basic Pathology. Elsevier,New Delhi :98

[4] Mega, J.L., Braunwald, E., Wiviott, S.D., 2012. Rivaroxaban in patients with a recent acute coronary syndrome. N Engl J Med, 366(1):9-19. 

[5] Patel, M.R., Mahaffey, K.W., Garg, J., 2011. Rivaroxaban versus warfarin in nonvalvular atrial fibrillation. N Engl J Med, 365(10):883-891. 

[6] Rahimtoola, A., Bergin, J.D., 2005. Acute pulmonary embolism: an update on diagnosis and management. Curr Probl Cardiol, 30(2):61-114. 

[7] Rakhit, R.D., 2003. Case 2: patent foramen ovale (PFO) and paradoxical embolism. Heart, 89(11):1362

[8] The EINSTEIN Investigators, 2010. Oral rivaroxaban for symptomatic venous thromboembolism. N Engl J Med, 363(26):2499-2510. 

[9] The EINSTEIN-PE Investigators, 2012. Oral rivaroxaban for the treatment of symptomatic pulmonary embolism. N Engl J Med, 366(14):1287-1297. 

[10] Wang, J.A., 2010. Advances in cardiovascular disease: how far is the summit?. J Zhejiang Univ-Sci B (Biomed & Biotechnol), 11(8):547

[11] Wang, J.A., 2012. Progress and challenges in the cardiovascular field. J Zhejiang Univ-Sci B (Biomed & Biotechnol), 13(8):587-588. 

[12] Yang, Y., Liang, L., Zhai, Z., 2011. Pulmonary embolism incidence and fatality trends in Chinese hospitals from 1997 to 2008: a multicenter registration study. PLoS ONE, 6(11):e26861

[13] Ying, S.Q., Xiang, M.X., Fang, L., 2010. Temporal changes in circulating P-selectin, plasminogen activator inhibitor-1, magnesium, and creatine kinase after percutaneous coronary intervention. J Zhejiang Univ-Sci B (Biomed & Biotechnol), 11(8):575-582. 

[14] Zhang, S., 2012. Clinical considerations of anticoagulation therapy for patients with atrial fibrillation. J Zhejiang Univ-Sci B (Biomed & Biotechnol), 13(8):609-615.