# Extensive Arteriovenous Fistula Thrombosis With Glucagon-Like Peptide-1 Agonist

## TL;DR

A woman developed rare blood clots in her arm after increasing her dose of a GLP-1 receptor agonist, a drug known for heart and kidney benefits.

## Contribution

This case report highlights a rare thrombotic complication linked to GLP-1 receptor agonists, adding to limited existing literature on this topic.

## Key findings

- A 55-year-old patient developed extensive thrombosis in her AV fistula and surrounding vessels after increasing GLP-1 agonist dosage.
- No inherited or acquired hypercoagulable states were found, suggesting a direct drug-related cause.
- Discontinuation of the GLP-1 agonist prevented further thrombotic events during follow-up.

## Abstract

Glucagon-like peptide-1 (GLP-1) receptor agonists are widely used due to their significant anti-atherosclerotic, cardiovascular, and renoprotective benefits. However, potential adverse effects must also be considered. Here, we present a rare case of GLP-1 receptor agonist-induced thrombotic complications in a middle-aged African American female, contributing to the limited existing literature on this topic. A 55-year-old African American female with a past medical history of deceased donor renal transplantation presented with pain, swelling, and erythema localized to the left arteriovenous (AV) fistula. She also reported fever, chills, and the absence of a palpable thrill over the fistula for approximately one week before presentation. On physical examination, she exhibited significant swelling of the left upper limb with no detectable thrill over the AV fistula. Venous and arterial Doppler ultrasound of the left upper extremity revealed extensive thrombosis involving the left AV fistula, brachiocephalic vein, and both the radial and ulnar arteries. An extensive prothrombotic workup, including evaluations for inherited and acquired hypercoagulable states, was unremarkable. The only notable change in her medical regimen was a recent dose escalation of her GLP-1 receptor agonist. Given the temporal association and absence of alternative causes, the thrombosis was attributed to the GLP-1 receptor agonist, which was subsequently discontinued. No further thrombotic events occurred during follow-up. This case highlights one of the rare thrombotic events of commonly used drugs, such as GLP-1 receptor agonists. This case also underscores the importance of life-threatening events of commonly used drugs, adding to the existing literature.