How To Stay Clear Of Vemurafenib Dilemmas

Footnotes Competing interests: None. Patient consent: Obtained. Provenance and peer review: Not commissioned; externally peer reviewed.""A 22-year-old primipara patient presented with swelling of both lower limb, started 15?days after delivery. She had normal vaginal delivery and delivered a normal baby. She does not have any significant family history. On general examination, she had non-pitting, tensed swelling of bilateral lower limb (right>left) with tenderness on palpation and vitals are stable. Systemic examination was found to be normal. Blood investigation showed only presence of anaemia (Hb 9.2?gm/dL). Venous Duplex scan showed thrombosis of right common iliac (CI), external iliac (EI), common femoral (CF), superficial femoral (SF) and popliteal vein (PV). As the patient was very young and had extensive DVT, so we planned for CDT in this case. An 8F SB431542 cell line sheath was inserted through ultrasound guidance in right PV. Check venogram performed after sheath insertion confirmed the findings of venous Doppler with extensive thrombus on right side (figure 1A) and extension of thrombus to left CI, EI vein and infrarenal inferior vena cava (figure 1B). So an 8F sheath was inserted in the left femoral vein (FV). Thromboaspiration was performed on both the sides by using 6F multipurpose catheter over a Terumo wire. Retrievable IVCF (Cordis Optease) was inserted through left FV and was placed below the renal vein. After that, angioplasty was performed by balloon dilation with 4��40?mm peripheral angioplasty balloon at 4 atm in both CI, EI, CF vein and up to IVC. 5F multipurpose catheter was put in the CI vein on right side. Local thrombolysis was started with injection streptokinase 150?000 units/h (divided into 70?000 units/h through catheter and 30?000 units/h through sheath in right side and 50?000 units/h through sheath in left side) along with injection heparin 1000 units/h through sheath in right PV. Mechanical thromboaspiration was performed twice and CDT had been given for 106?h. Check venogram was performed periodically. On the fifth day of CDT, check venogram showed complete clearance of thrombi and swelling of both the limb reduced. As there was significant stenosis seen in the bilateral CI vein even after lysis of clot with CDT, so bilateral venous angioplasty was performed in this case. The patient was then started on oral nicoumalone (4?mg/day) under the cover of injection heparin. She was discharged on 10th day after admission and discharge INR was 1.7. Injection of heparin had been given for 7?days. Graded compression stocking was also advised. After 2�C3?days of discharge, she had localised necrotic area over left leg which was superficial and managed by regular dressing in home.