Download PDF
CC BY 4.0 · TH Open 2023; 07(02): e94-e96
DOI: 10.1055/s-0043-57225
Case Report

Prolonged Fasting as a Cause of Deep Vein Thrombosis: A Case Report

Guillaume Roberge 
1   Centre d'Excellence des Maladies Vasculaires, Centre Hospitalier Universitaire de Québec, Université Laval, Hôpital Saint-François d'Assise, Québec, Canada
,
Carine Samson
2   MaClinique Médicale Lebourgneuf, Québec, Canada
,
Grégoire Le Gal 
3   Department of Medicine, Ottawa Hospital Research Institute, University of Ottawa, Ottawa, Ontario, Canada
,
Anthony Calabrino
1   Centre d'Excellence des Maladies Vasculaires, Centre Hospitalier Universitaire de Québec, Université Laval, Hôpital Saint-François d'Assise, Québec, Canada
› Author Affiliations
› Further Information
   Permissions and Reprints

Abstract

Background Intermittent fasting is becoming more popular as health benefits are described in recent literature. Various forms of fasting exist, one of them involving a zero-calorie diet and drinking only water. However, the safety of water-only fasting is still not well established. We report a case of a man who developed a lower limb deep vein thrombosis at the end of a 2-week water-only fasting and characterized by an initial period of 5 days of no food and no water intake. We reviewed literature regarding potential links between fasting and venous thromboembolism (VTE).

Clinical Approach We believe that fasting can induce important dehydration, leading to hypercoagulability and then contribute to the development of a venous thrombosis. The patient was treated with apixaban for 3 months as is recommended in patients with a provoked event caused by a transient risk factor. No thrombotic recurrence was observed during the 6-month follow-up.

Conclusion The public needs to be aware of the potential life-threatening complications associated with important dehydration in the setting of medically unsupervised fasting, and these might include VTE. Whether a VTE with dehydration as the only identified risk factor should be approached as a low recurrence risk situation or not still needs to be clarified.

Keywords

fasting - thrombosis - venous thrombosis - dehydration - anticoagulation


Publication History

Received: 31 January 2023

Accepted: 21 March 2023

Article published online:
20 April 2023

© 2023. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution License, permitting unrestricted use, distribution, and reproduction so long as the original work is properly cited. (https://creativecommons.org/licenses/by/4.0/)

Georg Thieme Verlag KG
Rüdigerstraße 14, 70469 Stuttgart, Germany

 

  • References

  • 1 de Cabo R, Mattson MP. Effects of intermittent fasting on health, aging, and disease. N Engl J Med 2019; 381 (26) 2541-2551
    CrossrefPubMedGoogle Scholar
  • 2 Longo VD, Mattson MP. Fasting: molecular mechanisms and clinical applications. Cell Metab 2014; 19 (02) 181-192
    CrossrefPubMedGoogle Scholar
  • 3 Wilhelmi de Toledo F, Buchinger A, Burggrabe H. et al. Fasting therapy-an expert panel update of the 2002 Consensus Guidelines Revised Consensus Guidelines for Fasting Therapy 435. Forsch Komplement Med 2013; 20: 434-443
    PubMedGoogle Scholar
  • 4 Ogłodek E, Pilis Prof W. Is water-only fasting safe?. Glob Adv Health Med 2021. Doi: 10:21649561211031178
    PubMedGoogle Scholar
  • 5 Finnell JS, Saul BC, Goldhamer AC, Myers TR. Is fasting safe? A chart review of adverse events during medically supervised, water-only fasting. BMC Complement Altern Med 2018; 18 (01) 67
    CrossrefPubMedGoogle Scholar
  • 6 Kerndt PR, Naughton JL, Driscoll CE, Loxterkamp DA. Fasting: the history, pathophysiology and complications. West J Med 1982; 137 (05) 379-399
    PubMedGoogle Scholar
  • 7 Brett AS, Nesbit RM. A 40-day water-only fast by a Pentecostal woman: clinical and religious observations. Am J Med Sci 2013; 345 (05) 418-420
    CrossrefPubMedGoogle Scholar
  • 8 Goldhamer A, Lisle D, Parpia B, Anderson SV, Campbell TC. Medically supervised water-only fasting in the treatment of hypertension. J Manipulative Physiol Ther 2001; 24 (05) 335-339
    CrossrefPubMedGoogle Scholar
  • 9 Fang Y, Gu Y, Zhao C. et al. Impact of supervised beego, a traditional Chinese water-only fasting, on thrombosis and haemostasis. BMJ Nutr Prev Health 2021; 4 (01) 4-17
    CrossrefPubMedGoogle Scholar
  • 10 Heyman SN, Bursztyn M, Szalat A, Muszkat M, Abassi Z. Fasting-induced natriuresis and SGLT: a new hypothesis for an old enigma. Front Endocrinol (Lausanne) 2020; 11: 217
    CrossrefPubMedGoogle Scholar
  • 11 Maagøe H. Changes in blood volume during absolute fasting with and without sodium chloride administration. Metabolism 1968; 17 (02) 133-138
    CrossrefPubMedGoogle Scholar
  • 12 Spark RF, Arky RA, Boulter PR, Saudek CD, O'Brian JT. Renin, aldosterone and glucagon in the natriuresis of fasting. N Engl J Med 1975; 292 (25) 1335-1340
    CrossrefPubMedGoogle Scholar
  • 13 Korbonits M, Blaine D, Elia M, Powell-Tuck J. Metabolic and hormonal changes during the refeeding period of prolonged fasting. Eur J Endocrinol 2007; 157 (02) 157-166
    CrossrefPubMedGoogle Scholar
  • 14 Gavish I, Brenner B. Air travel and the risk of thromboembolism. Intern Emerg Med 2011; 6 (02) 113-116
    CrossrefPubMedGoogle Scholar
  • 15 Chee YL, Watson HG. Air travel and thrombosis. Br J Haematol 2005; 130 (05) 671-680
    CrossrefPubMedGoogle Scholar
  • 16 Kelly J, Hunt BJ, Lewis RR. et al. Dehydration and venous thromboembolism after acute stroke. QJM 2004; 97 (05) 293-296
    CrossrefPubMedGoogle Scholar
  • 17 Hull CM, Harris JA. Cardiology patient page. Venous thromboembolism and marathon athletes. Circulation 2013; 128 (25) e469-e471
    PubMedGoogle Scholar
  • 18 Richard S, Lacour JC, Frotscher B, Enea A, Mione G, Ducrocq X. Report of a recurrent cerebral venous thrombosis in a young athlete. BMC Neurol 2014; 14 (01) 182
    CrossrefPubMedGoogle Scholar
  • 19 Lee KW, Lip GYH. Acute versus habitual exercise, thrombogenesis and exercise intensity. Thromb Haemost 2004; 91 (03) 416-419
    Article in Thieme ConnectPubMedGoogle Scholar
  • 20 Kuo EY, Chung MH, Lin HJ, Chen KT. Gastroenteritis followed by headache: a rare presentation of cerebral venous thrombosis. J Acute Med 2012; 2 (03) 92-94
    CrossrefPubMedGoogle Scholar
  • 21 Elias S, Hoffman R, Saharov G, Brenner B, Nadir Y. Dehydration as a possible cause of monthly variation in the incidence of venous thromboembolism. Clin Appl Thromb Hemost 2016; 22 (06) 569-574
    CrossrefPubMedGoogle Scholar
  • 22 Miettinen M. Effect of fasting on fibrinolysis and blood coagulation. Am J Cardiol 1962; 10 (04) 532-534
    CrossrefPubMedGoogle Scholar
  • 23 Kearon C, Ageno W, Cannegieter SC, Cosmi B, Geersing G-J, Kyrle PA. Subcommittees on Control of Anticoagulation, and Predictive and Diagnostic Variables in Thrombotic Disease. Categorization of patients as having provoked or unprovoked venous thromboembolism: guidance from the SSC of ISTH. J Thromb Haemost 2016; 14 (07) 1480-1483
    CrossrefPubMedGoogle Scholar
  • 24 Stevens SM, Woller SC, Kreuziger LB. et al. Antithrombotic therapy for VTE disease: second update of the CHEST Guideline and Expert Panel Report. Chest 2021; 160 (06) e545-e608
    CrossrefPubMedGoogle Scholar