Thrombosis of the internal jugular vein after tympanoplasty caused by interaction of oral contraceptives and hereditary hypofibrinolysis

This case report describes a case of venous thrombosis in a young woman who had undergonetympanoplasty due to chronic otitis media.Other than that she was healthy. According to the anamnesis she stopped taking oral contraceptive pills (OCP) a month before the surgery. She did not receive thromboprophylaxis before the surgerybecause it was estimated that there was a low risk for a thromboembolic incident. Several hours after the surgery she was still not responding properly to external stimulus and there was noverbal contact. An urgent computed tomography (CT) scan of head and neck revealed thrombosis of the left internal jugular vein. She was admitted to the Intensive Care Unit (ICU) and heparin therapy started. After a few days she was fully recovered. Later it was confirmed that the patient had an inherited fibrinolysis disorder caused by plasminogen activator inhibitor 1 (PAI-1) gene polymorphism. Our opinion is that the unexpected thrombotic incident was a result of interaction of multiple factors, including the venous stasis at the surgery site, decreased fibrinolysis ability, and the prothrombotic effect of OCP.