A Case of Trousseau Syndrome: A Report Detailing Recurrent Ischaemic Strokes Associated With Metastatic Pancreatic Cancer and Pulmonary Embolisms Despite Treatment With Direct Oral Anticoagulation.

Pancreatic cancer is a malignancy strongly associated with cancer-related hypercoagulability. Venous thromboses are a well-documented complication of pancreatic cancer, but there is less awareness and focus on arterial events such as ischaemic stroke and myocardial infarction. We present the case of a patient who was diagnosed with ischaemic stroke preceding a diagnosis of an occult metastatic pancreatic malignancy and concurrent pulmonary embolism. Despite treatment with therapeutic doses of direct oral anticoagulation, the patient subsequently developed recurrent bilateral ischaemic strokes. This case highlights the challenges of managing mixed venous and arterial thromboembolic disease in patients with pancreatic cancer and illustrates the aggressive, refractory nature of Trousseau syndrome.