Combined life-threatening thromboses and hemorrhages in a patient with afibrinogenemia and antithrombin deficiency

a Sagittal computed tomography angiography showing a left cerebellar hemisphere hemorrhage. b Thrombin generation curves obtained with 5pM tissue factor and 4 μM phospholipids (final concentration) in platelet-poor plasma using calibrated automated thrombin generation assay (Stago, Asnières, France). The area under the thrombin generation curve (or endogenous thrombin potential) is significantly higher in the patient (red) compared to another subject with afibrinogenemia (blue) or a representative normal control (grey). In this patient with combined inherited antithrombin and fibrinogen deficiency, increased thrombin generation is due to insufficient inhibition of thrombin. Thrombin generation is decreased after infusion of 30 U/kg antithrombin concentrate (pink). c Visualization of the left coronary artery with computed tomography coronary angiogram showing 80% stenosis in the common trunk. d Visualization of the left coronary artery with computed tomography coronary angiogram showing 50% stenosis in the anterior interventricular branch of left coronary arter