Successful treatment with rivaroxaban for an acute pulmonary thromboembolism in a patient with primary antiphospholipid antibody syndrome

Abstract

A 73-year-old man was admitted with sudden onset of dyspnea. Contrast-enhanced computed tomography showed acute pulmonary thromboembolism and deep vein thrombosis. He was started on the direct oral anticoagulant rivaroxaban (factor Xa inhibitor) and this resolved the thrombus. Serological analysis revealed that his risk of thrombosis was primary antiphospholipid syndrome (APS). He has remained free of recurrent venous thromboembolism (VTE) for two years while under rivaroxaban. We present a case with VTE due to APS for whom direct oral anticoagulant was effective. <Learning objective: Direct oral anticoagulants (DOAC) have become agents of first choice in the treatment of acute to chronic period pulmonary thromboembolism for most patients. However, the effects of DOAC on acute pulmonary thromboembolism (APTE) in patients with antiphospholipid syndrome (APS) remain obscure. The standard treatment for thrombotic APS is initial anticoagulation with unfractionated heparin or a low-molecular-weight heparin followed by warfarin. DOAC may be useful for some APTE patients with APS.>.

Keywords: Anti-cardiolipin antibody; Lupus anticoagulant; Thrombus; Venous thromboembolism.

Fig. 1

Contrast-enhanced computed tomography findings. Findings on admission show multiple thrombi in bilateral pulmonary arteries (arrows; A, B) and thrombus in the enlarged left popliteal vein (arrow; C). Findings at 15 days after admission show that bilateral pulmonary arteries are almost completely free of all thrombi (D, E) and that thrombus in the left popliteal vein has decreased in size (arrow; F).