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

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.

Keywords: Deep vein thrombosis; Edoxaban; Factor Xa inhibitor; Fondaparinux; Venous thromoboembolism.

Fig. 1

Ultrasonography showing the regression of deep venous thrombosis. a Ultrasonography (iU-22, Philips) images of the left lower extremity showing extensive deep vein thrombosis at the initial examination (1 month after the first appearance of symptoms); Additional file 1. b Ultrasonography (Noblus, Hitachi Aloka Medical) images of the left lower extremity after 3 months of treatment; Additional file 2. Although some thrombi are still visible in the popliteal vein, no remaining thrombi were observed in the left superficial femoral and soleus muscle veins. c Ultrasonography (Aplio XG, Toshiba) images of the left lower extremity after 6 months of treatment; Additional file 3. No remaining thrombi were observed and only mural thrombi remained in the popliteal vein