Skip to main content
Top
Published in: Thrombosis Journal 1/2016

Open Access 01-12-2016 | Case report

Extensive deep vein thrombosis treatment using fondaparinux and edoxaban: a case report

Authors: Kazuhiro Shimizu, Takeshi Sasaki, Takanobu Tomaru, Hirofumi Noike

Published in: Thrombosis Journal | Issue 1/2016

Login to get access

Abstract

Background

Factor Xa inhibitor is a key drug in the coagulation cascade. Parenteral anticoagulation using low molecular weight heparin or fondaparinux is the recommended form of treatment for most patients presenting with venous thrombosis. Following the acute phase, edoxaban is recommended. We present a case of extensive deep vein thrombosis treated using fondaparinux and edoxaban.

Case presentation

A 63-year-old man with redness, pain, and swelling of the left leg lasting for more than 1 month was referred to our hospital. Ultrasonography revealed a thrombus in the left femoral vein. Computed tomographic angiography revealed clots in the distal right pulmonary artery. Thus, the anticoagulant treatment was initiated with subcutaneous injections of fondaparinux (7.5 mg) for 5 consecutive days, followed by once daily oral administration of edoxaban (60 mg). After 3 months of treatment, a regression of thrombotic clots was shown. Three months later, the remaining clots disappeared, leaving only mural thrombi; no bleeding complications were observed during the treatment period.

Conclusion

The anticoagulant treatment with subcutaneous fondaparinux and subsequently with oral edoxaban was effective for treating extensive deep vein thrombosis.
Appendix
Available only for authorised users
Literature
1.
go back to reference Goldhaber SZ, Bounameaux H. Pulmonary embolism and deep vein thrombosis. Lancet. 2012;379:1835–46.CrossRefPubMed Goldhaber SZ, Bounameaux H. Pulmonary embolism and deep vein thrombosis. Lancet. 2012;379:1835–46.CrossRefPubMed
2.
go back to reference Fuji T, Fujita S, Tachibana S, Kawai Y. A dose-ranging study evaluating the oral factor Xa inhibitor edoxaban for the prevention of venous thromboembolism in patients undergoing total knee arthroplasty. J Thromb Haemost. 2010;8:2458–68.CrossRefPubMed Fuji T, Fujita S, Tachibana S, Kawai Y. A dose-ranging study evaluating the oral factor Xa inhibitor edoxaban for the prevention of venous thromboembolism in patients undergoing total knee arthroplasty. J Thromb Haemost. 2010;8:2458–68.CrossRefPubMed
3.
go back to reference Raskob G, Cohen AT, Eriksson BI, Puskas D, Shi M, Bocanegra T, et al. Oral direct factor Xa inhibition with edoxaban for thromboprophylaxis after elective total hip replacement: a randomised double-blind dose–response study. Thromb Haemost. 2010;104:642–9.CrossRefPubMed Raskob G, Cohen AT, Eriksson BI, Puskas D, Shi M, Bocanegra T, et al. Oral direct factor Xa inhibition with edoxaban for thromboprophylaxis after elective total hip replacement: a randomised double-blind dose–response study. Thromb Haemost. 2010;104:642–9.CrossRefPubMed
4.
go back to reference Weitz JI, Connolly SJ, Patel I, Salazar D, Rohatagi S, Mendell J, et al. Randomised, parallel-group, multicentre, multinational phase 2 study comparing edoxaban, an oral factor Xa inhibitor, with warfarin for stroke prevention in patients with atrial fibrillation. Thromb Haemost. 2010;104:633–41.CrossRefPubMed Weitz JI, Connolly SJ, Patel I, Salazar D, Rohatagi S, Mendell J, et al. Randomised, parallel-group, multicentre, multinational phase 2 study comparing edoxaban, an oral factor Xa inhibitor, with warfarin for stroke prevention in patients with atrial fibrillation. Thromb Haemost. 2010;104:633–41.CrossRefPubMed
5.
go back to reference Nakamura M, Miyata T, Ozeki Y, Takayama M, Komori K, Yamada N, et al. Current venous thromboembolism management and outcomes in Japan. Circ J. 2014;78:708–17.CrossRefPubMed Nakamura M, Miyata T, Ozeki Y, Takayama M, Komori K, Yamada N, et al. Current venous thromboembolism management and outcomes in Japan. Circ J. 2014;78:708–17.CrossRefPubMed
6.
go back to reference Lozano F, Trujillo-Santos J, Barrón M, Gallego P, Babalis D, Santos M, et al. Home versus in-hospital treatment of outpatients with acute deep venous thrombosis of the lower limbs. J Vasc Surg. 2014;59:1362–7.CrossRefPubMed Lozano F, Trujillo-Santos J, Barrón M, Gallego P, Babalis D, Santos M, et al. Home versus in-hospital treatment of outpatients with acute deep venous thrombosis of the lower limbs. J Vasc Surg. 2014;59:1362–7.CrossRefPubMed
7.
go back to reference Buller HR, Davidson BL, Decousus H, Gallus A, Gent M, Piovella F, Prins MH, Raskob G, van den Berg-Segers AE, Cariou R, Leeuwenkamp O, Lensing AW. Subcutaneous fondaprinux versus intravenous unfractionated heparin in the initial treatment of pulmonary embolism. N Engl J Med. 2003;349(18):1695–702.CrossRefPubMed Buller HR, Davidson BL, Decousus H, Gallus A, Gent M, Piovella F, Prins MH, Raskob G, van den Berg-Segers AE, Cariou R, Leeuwenkamp O, Lensing AW. Subcutaneous fondaprinux versus intravenous unfractionated heparin in the initial treatment of pulmonary embolism. N Engl J Med. 2003;349(18):1695–702.CrossRefPubMed
8.
go back to reference Spyropoulos AC. Outpatient-based treatment protocols in the management of venous thromboembolic disease. Am J Manag Care. 2000;6(20 Suppl):1034–44. Spyropoulos AC. Outpatient-based treatment protocols in the management of venous thromboembolic disease. Am J Manag Care. 2000;6(20 Suppl):1034–44.
9.
go back to reference Hokusai VTE Investigators, Büller HR, et al. Edoxaban versus warfarin for the treatment of symptomatic venous thromboembolism. N Engl J Med. 2013;369:1406–15.CrossRef Hokusai VTE Investigators, Büller HR, et al. Edoxaban versus warfarin for the treatment of symptomatic venous thromboembolism. N Engl J Med. 2013;369:1406–15.CrossRef
10.
go back to reference Schulman S, et al. Treatment of acute venous thromboembolism with dabigatran or warfarin and pooled analysis. Circulation. 2014;129:764–72.CrossRefPubMed Schulman S, et al. Treatment of acute venous thromboembolism with dabigatran or warfarin and pooled analysis. Circulation. 2014;129:764–72.CrossRefPubMed
11.
go back to reference Schulman S, et al. Dabigatran versus warfarin in the treatment of acute venous thromboembolism. N Engl J Med. 2009;361:2342–52.CrossRefPubMed Schulman S, et al. Dabigatran versus warfarin in the treatment of acute venous thromboembolism. N Engl J Med. 2009;361:2342–52.CrossRefPubMed
12.
go back to reference Grip LT, Ruff CT, Giugliano RP. New oral antithrombotic strategies: 2013 update on atrial fibrillation. Hot Topics Cardiol. 2013;8(31):7–19. Grip LT, Ruff CT, Giugliano RP. New oral antithrombotic strategies: 2013 update on atrial fibrillation. Hot Topics Cardiol. 2013;8(31):7–19.
13.
go back to reference Bathala MS, Masumoto H, Oguma T, He L, Lowrie C, Mendell J. Pharmacokinetics, biotransformation, and mass balance of edoxaban, a selective, direct factor xa inhibitor, in humans. Drug Metab Dispos. 2012;40(12):2250–5.CrossRefPubMed Bathala MS, Masumoto H, Oguma T, He L, Lowrie C, Mendell J. Pharmacokinetics, biotransformation, and mass balance of edoxaban, a selective, direct factor xa inhibitor, in humans. Drug Metab Dispos. 2012;40(12):2250–5.CrossRefPubMed
14.
go back to reference Zahir H, Matsushima N, Halim AB, He L, Zhang G, Lee F, et al. Edoxaban administration following enoxaparin: a pharmacodynamic, pharmacokinetic, and tolerability assessment in human subjects. Thromb Haemost. 2012;108(1):166–75.CrossRefPubMed Zahir H, Matsushima N, Halim AB, He L, Zhang G, Lee F, et al. Edoxaban administration following enoxaparin: a pharmacodynamic, pharmacokinetic, and tolerability assessment in human subjects. Thromb Haemost. 2012;108(1):166–75.CrossRefPubMed
15.
go back to reference Laporte S, MIsmetti P, Decousus H, Uresandi F, Otero R, Lobo JL, et al. Clinical predictors for fatal pulmonary embolism in 15,520 patients with venous thromboembolism: Finding from the Registro Informatizado de la Enfermedad ThromboEmbolica venosa (RIETE) Registry. Circulation. 2008;117:1711–6.CrossRefPubMed Laporte S, MIsmetti P, Decousus H, Uresandi F, Otero R, Lobo JL, et al. Clinical predictors for fatal pulmonary embolism in 15,520 patients with venous thromboembolism: Finding from the Registro Informatizado de la Enfermedad ThromboEmbolica venosa (RIETE) Registry. Circulation. 2008;117:1711–6.CrossRefPubMed
16.
go back to reference Vítovec M, Golán L, Roztocil K, Linhart A. The development of persistent thrombotic masses in patients with deep venous thrombosis randomized to long-term anticoagulation treatment. Vasa. 2009;38:238–44.CrossRefPubMed Vítovec M, Golán L, Roztocil K, Linhart A. The development of persistent thrombotic masses in patients with deep venous thrombosis randomized to long-term anticoagulation treatment. Vasa. 2009;38:238–44.CrossRefPubMed
17.
go back to reference Medved L, Nieuwenhuizen W. Molecular mechanisms of initiation of fibrinolysis by fibrin. J Thromb Haemost. 2003;89:409–19. Medved L, Nieuwenhuizen W. Molecular mechanisms of initiation of fibrinolysis by fibrin. J Thromb Haemost. 2003;89:409–19.
18.
go back to reference Morishima Y, Kamisato C, Honda Y. Treatment of venous thrombosis with an oral direct factor Xa inhibitor edoxaban by single and multiple administrations in rats. Eur J Pharmacol. 2014;742:15–21.CrossRefPubMed Morishima Y, Kamisato C, Honda Y. Treatment of venous thrombosis with an oral direct factor Xa inhibitor edoxaban by single and multiple administrations in rats. Eur J Pharmacol. 2014;742:15–21.CrossRefPubMed
19.
go back to reference Morishima Y, Honda Y, Kamisato C, Shibano T. Comparison of antithrombotic and hemorrhagic effects of edoxaban, a novel factor Xa inhibitor, with unfractionated heparin, dalteparin, lepirudin and warfarin in rats. Thromb Res. 2013;132:234–9.CrossRefPubMed Morishima Y, Honda Y, Kamisato C, Shibano T. Comparison of antithrombotic and hemorrhagic effects of edoxaban, a novel factor Xa inhibitor, with unfractionated heparin, dalteparin, lepirudin and warfarin in rats. Thromb Res. 2013;132:234–9.CrossRefPubMed
Metadata
Title
Extensive deep vein thrombosis treatment using fondaparinux and edoxaban: a case report
Authors
Kazuhiro Shimizu
Takeshi Sasaki
Takanobu Tomaru
Hirofumi Noike
Publication date
01-12-2016
Publisher
BioMed Central
Published in
Thrombosis Journal / Issue 1/2016
Electronic ISSN: 1477-9560
DOI
https://doi.org/10.1186/s12959-016-0089-x

Other articles of this Issue 1/2016

Thrombosis Journal 1/2016 Go to the issue