Catastrophic arteriovenous thromboembolism as initial manifestation of pancreatic cancer.

CONTEXT: The association between cancer and thrombosis is well-known. Among gastrointestinal malignancies, pancreatic cancer has perhaps the strongest association with thromboembolic events. However, simultaneous arterial and venous thromboses affecting multiple organs at the time of initial diagnosis is rare, with an incidence of less than 1%. CASE REPORT: We report herein a case of a 61-year-old woman who presented with digital ischemia, a non-ST elevation myocardial infarction and an ischemic stroke, along with deep vein thromboses and pulmonary embolism. She was subsequently diagnosed with metastatic pancreatic cancer. DISCUSSION: This report highlights the intriguing association between pancreatic cancer biology, tumor metastases, and triggering of venous and arterial thromboembolic events. Current evidence points towards early thromboembolic phenomena as a harbinger of poor outcome in pancreatic cancer, and studies attempting to define the role of prophylactic anticoagulation in these patients are ongoing.