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PAI-1 polymorphism as a cause of severe high altitude associated arteriovenous thrombosis
  1. Velu Nair1,
  2. Uday Yanamandra2,3,
  3. Rai Kumud4,
  4. Kanjakya Ghosh5
  1. 1Armed Forces Medical Services, Army Medical Corps (Indian Army), New Delhi, India
  2. 2Department of Internal Medicine, Armed Forces Medical College, Pune, Maharashtra, India
  3. 3Department of Internal Medicine, Post Graduate Institute of Medical Education and Research, Chandigarh, Chandigarh, India
  4. 4Department of Vascular Surgery, Max Super Specialty Hospital, New Delhi, Delhi, India
  5. 5Department of Immunohematology & Hematopathology, Surat Raktadan Kendra & Research Centre, Surat, Gujarat, India
  1. Correspondence to Dr Uday Yanamandra, udayj2{at}


We present a 34-year-old man who developed disseminated intra-arterial and venous thrombosis following exposure to extreme high altitude. On evaluation, the patient was found to have thrombosis involving the aorta, bilateral iliac arteries and middle cerebral artery. On detailed evaluation for the cause of recurrent seizures, he was also found to have cerebral venous thrombosis of the superior sagittal sinus. The patient underwent amputation of 3 limbs due to gangrene. Procoagulant work up revealed increased plasminogen activator inhibitor-1 activity with 4G/4G polymorphism. This case highlights the life-threatening and limb-threatening thrombosis secondary to a rare inherited thrombophilia on exposure to extreme high altitude.

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  • Contributors VN and RK were involved in the initial management of the case. KG conducted a detailed thrombophilia profile continuously over the past 10 years. VN and UY followed up the patient for the past 10 years. VN and UY drafted and approved the manuscript.

  • Competing interests None declared.

  • Patient consent Obtained.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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