Behcet's disease and refractory thrombosis

### Learning Point for Clinicians Venous thromboembolism despite anticoagulation and antiplatelet agents is a rare phenomenon. Behcet’s disease is a vasculitic disorder where thrombosis can develop in different circulations, despite standard antithrombotic therapy. Immunosuppression to control the inflammatory element of this condition can however prevent thrombosis in Behcet’s disease. A 52-year-old Caucasian female presented with a history of extensive and recurrent thrombosis over a period of 3 years despite adequate anticoagulation with dabigatran and aspirin. She had previously taken warfarin, Sinthrome and low-molecular-weight heparin. Major thromboses were located in the subclavian veins, and complete occlusion of the left brachiocephalic vein in addition to deep vein thrombosis of the lower limbs. Chronic thrombi in these vessels led to facial/upper limb oedema, headaches and post-thrombotic syndrome. …