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Case Reports
. 2019 Aug 15;12(8):e228427.
doi: 10.1136/bcr-2018-228427.

Successful intravenous administration of argatroban in the management of heparin-resistant and surgery-resistant mesenteric vein thrombosis

Yuya Yokota  1 , Takashi Yoshioka  2 , Mayumi Senoh  1 , Kazuharu Sunami  1
Affiliations
Case Reports

Successful intravenous administration of argatroban in the management of heparin-resistant and surgery-resistant mesenteric vein thrombosis

Yuya Yokota et al. BMJ Case Rep. .

Abstract

A 78-year-old woman visited the emergency department with complaints of progressively worsening abdominal pain for a week. Nausea and vomiting started at the time of the visit. An abdominal contrast-enhanced CT (CECT) revealed a filling defect of portal vein, splenic vein and superior mesenteric vein (SMV) which was diagnosed as portal vein and mesenteric venous thrombosis (MVT). Intravenous administration of unfractionated heparin was initiated. However, her symptoms did not improve, and she underwent surgical thrombectomy on the second day of hospitalisation. On the sixth day, CECT revealed the recurrence of thrombi in the portal vein, SMV and along the central venous catheters. We switched heparin to argatroban on the eighth day. After administering argatroban, CECT revealed that the thrombi had almost disappeared by the 40th day. In this case, argatroban was considered effective for heparin-resistant and surgery-resistant portal vein and MVT.

Keywords: haematology (incl blood transfusion); stomach and duodenum; venous thromboembolism.

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Conflict of interest statement

Competing interests: None declared.

Figures

Figure 1
Figure 1
Contrast-enhanced CT on admission showed a defect in the portal vein (A, C; arrow) extending to the superior mesenteric vein (B; arrow), in which thrombus was suspected, in addition to thickening of the jejunal wall (C; arrow).
Figure 2
Figure 2
CECT on the eighth day of hospitalisation showed that thrombi were found in the inferior vena cava (A, arrow), the right internal jugular vein (B, arrow) and the right iliac vein (C, arrow) along the central venous catheter.
See this image and copyright information in PMC

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