Tehran University of Medical Sciences The Research in Heart Yield and Translational Medicine (RHYTHM) 3115-7270 19 4 2024 10 30 295 301 Venus Shahabi Raberi Department of Cardiology, Seyedoshohda Hospital, School of Medicine, Urmia University of Medical Sciences, Urmia, Iran. Ozra Kahourian Department of Cardiology, Seyedoshohda Hospital, School of Medicine, Urmia University of Medical Sciences, Urmia, Iran. Reza Faramarz Zadeh Department of Cardiology, Seyedoshohda Hospital, School of Medicine, Urmia University of Medical Sciences, Urmia, Iran. Razieh Parizad 1) Cardiovascular Research Center, Tabriz University of Medical Sciences, Tabriz, Iran. 2)Faculty of Nursing and Midwifery, Tabriz University of Medical Sciences, Tabriz, Iran. Oliver McConnell Consultant Cardiologist, Wrightington, Wigan and Leigh NHS Foundation Trust, Wigan, UK. Alireza Rostamzadeh Department of Cardiology, Seyedoshohda Hospital, School of Medicine, Urmia University of Medical Sciences, Urmia, Iran. 2024 04 04 2024 09 24 Thrombotic manifestations involve the development of blood clots within blood vessels. These conditions can occur unexpectedly in different areas and are often linked to life-threatening situations, presenting challenges for both diagnosis and treatment. We present a case of multi-site thrombosis in a patient with a confirmed hypercoagulable state, resulting from a positive factor V Leiden mutation. The patient’s medical history included hypertension, chronic obstructive pulmonary disease, previous thrombotic events, and changes in anticoagulant therapy. This case highlights the challenges associated with multisystem thrombosis and underscores the necessity of employing various diagnostic techniques, such as echocardiography, computed coronary angiography, and Doppler ultrasonography. In this instance, the patient presented with a history of unprovoked lower limb deep vein thrombosis and multiple arterial thromboses. The patient’s treatment regimen comprised anticoagulants, antiplatelet drugs, and vasodilators. While a reduction in thrombus size was noted, complete revascularization could not be attained. Effective diagnosis and treatment of venous and arterial thrombosis often require multimodal imaging. Selective blood test screening can be beneficial in diagnosing or detecting inherited or acquired abnormalities linked to thrombosis development. https://rhythm.tums.ac.ir/index.php/jthc/article/view/2059