Skip to main content
SpringerLink
Log in

Venous thromboembolism in anorexia nervosa: four cases from a specialized unit. Indication for thromboprophylaxis?

  • Case Report
  • Published:
Eating and Weight Disorders - Studies on Anorexia, Bulimia and Obesity Aims and scope Submit manuscript

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.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

References

  1. Winkler LA, Bilenberg N, Hørder K, Støving RK (2015) Does specialization of treatment influence mortality in eating disorders? A comparison of two retrospective cohorts. Psychiatry Res 230(2):165–171. https://doi.org/10.1016/j.psychres.2015.08.032

    Article  PubMed  Google Scholar 

  2. Derman T, Szabo CP (2006) Why do individuals with anorexia die? A case of sudden death. Int J Eat Disord 39:260–262. https://doi.org/10.1002/eat.20229

    Article  PubMed  Google Scholar 

  3. Tirabassi G, Boscaro M, Arnaldi G (2014) Harmful effects of functional hypercortisolism: a working hypothesis. Endocrine 46(3):370–386. https://doi.org/10.1007/s12020-013-0112-y(Epub 2013 Nov 27. Review. PubMed PMID: 24282037)

    Article  CAS  PubMed  Google Scholar 

  4. MARSIPAN Working Group (2014) Management of really sick patients with anorexia nervosa (MARSIPAN). Royal College of Psychiatrist and Royal College of Physicans. London 2014. College Report 189

  5. Connors JM (2017) Thrombophilia testing and venous thrombosis. N Engl J Med 377:1177–1187. https://doi.org/10.1056/NEJMra1700365

    Article  PubMed  Google Scholar 

  6. Garber AK, Sawyer SM, Golden NH, Guarda AS, Katzman DK, Kohn MR, Le Grange D, Madden S, Whitelaw M, Redgrave GW (2016) A systematic review of approaches to refeeding in patients with anorexia nervosa. Int J Eat Disord 49(3):293–310. https://doi.org/10.1002/eat.22482

    Article  PubMed  Google Scholar 

  7. Hunt BJ (2018) Hemostasis at extremes of body weights in thrombosis and hemostatis. Expert Rev Hematol 44(7):632–639. https://doi.org/10.1055/s-0038-1661385

    Article  Google Scholar 

  8. Ogston D, Ogston WD (1976) The fibrinolytic enzyme system in anorexia nervosa. Acta Haematol 55(04):230–233. https://doi.org/10.1159/000208019

    Article  CAS  PubMed  Google Scholar 

  9. Luck P, Mikhailidis DP, Dashwood MR et al (1983) Platelet hyperaggregability and increased alpha-adrenoceptor density in anorexia nervosa. J Endocrinol Metab. 57(05):911–914. https://doi.org/10.1016/0262-1746(87)90104-1

    Article  CAS  Google Scholar 

  10. Gaudiani JL, Kashuk JL, Chu ES et al (2010) The use of thrombelastography to determine coagulation status in severe anorexia nervosa: a case series. Int J Eat Disord 43:382–385. https://doi.org/10.1002/eat.20691

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Center for Eating Disorders, Odense University Hospital, Odense, Denmark

    Zainab Abdelhadi & René Klinkby Støving

  2. Unit for Thrombosis Research, Department of Regional Health Research, The University of Southern Denmark, Odense, Denmark

    Else Marie Bladbjerg

  3. Department of Clinical Biochemistry, Hospital of South West Jutland, Esbjerg, Denmark

    Else Marie Bladbjerg

  4. Steno Diabetes Center Odense, Odense University Hospital, Odense, Denmark

    Dorte Møller Jensen

  5. Department of Gynecology and Obstetrics, Odense University Hospital, Odense, Denmark

    Dorte Møller Jensen

  6. Department of Clinical Science, University of Southern Denmark, Odense, Denmark

    Dorte Møller Jensen

  7. Elite Research Center for Medical Endocrinology, Odense University Hospital, Odense, Denmark

    Amalie Schousboe & René Klinkby Støving

  8. Mental Health Services in the Region of Southern Denmark, Odense, Denmark

    René Klinkby Støving

  9. Clinical Institute, University of Southern Denmark, Odense, Denmark

    René Klinkby Støving

Authors
  1. Zainab Abdelhadi
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Else Marie Bladbjerg
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Dorte Møller Jensen
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Amalie Schousboe
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. René Klinkby Støving
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to René Klinkby Støving.

Ethics declarations

Conflict of interest

The authors have no conflict of interest.

Informed consent

Informed consent for publication of this case study/report was obtained from the four individual participants.

Ethical approval

All procedures performed in the study were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Abdelhadi, Z., Bladbjerg, E.M., Jensen, D.M. et al. Venous thromboembolism in anorexia nervosa: four cases from a specialized unit. Indication for thromboprophylaxis?. Eat Weight Disord 25, 1833–1837 (2020). https://doi.org/10.1007/s40519-019-00830-5

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s40519-019-00830-5

Keywords

Search

Navigation