Cook Rhett M, Rondina Matthew T, Horton Devin J
University of Utah Health Sciences Center, Salt Lake City, UT, USA.
University of Utah Health Sciences Center, Salt Lake City, UT, USA
Ann Pharmacother. 2014 Aug;48(8):1055-1060. doi: 10.1177/1060028014533304. Epub 2014 May 5.
To report a case where rivaroxaban was used in the management of an ovarian vein thrombosis and to briefly review the literature, pathophysiology, and clinical implications therein.
A 30-year-old previously healthy woman was diagnosed with acute, spontaneous, left-ovarian vein thrombosis (OVT) with proximal extension into the renal vein. After initial catheter-directed thrombolysis with tPA, angioplasty of the left renal vein, and heparinoid treatment, rivaroxaban was begun for long-term anticoagulation. Three months after her index event she was symptom free, with complete resolution of her thrombosis and no adverse effects or bleeding complications from rivaroxaban. To our knowledge, this is the first report of OVT successfully treated with rivaroxaban.
OVT is a rare but potentially fatal cause of abdominal pain that may pose diagnostic and therapeutic dilemmas. Factor V Leiden (FVL) homozygosity, an uncommon but severe inherited thrombophilia, increases the risk of thrombosis by approximately 50- to 80-fold. This case report and accompanying literature review highlight important clinical pearls related to the diagnosis and management of OVT and inherited thrombophilias.
This clinical vignette adds to the published literature suggesting that novel oral anticoagulants, such as rivaroxaban, may eventually emerge as an alternative to vitamin K antagonists for the treatment of extra-axial thromboses. Reporting these cases is important because their prevalence is low outside of specialized referral centers, and thus, dissemination of these experiences may help other providers in treating their patients.
报告一例使用利伐沙班治疗卵巢静脉血栓形成的病例，并简要回顾相关文献、病理生理学及其中的临床意义。
一名30岁既往健康的女性被诊断为急性自发性左卵巢静脉血栓形成（OVT），血栓近端延伸至肾静脉。在最初采用组织型纤溶酶原激活剂（tPA）进行导管定向溶栓、左肾静脉血管成形术及类肝素治疗后，开始使用利伐沙班进行长期抗凝治疗。在其发病事件三个月后，她无症状，血栓完全溶解，且未出现利伐沙班的不良反应或出血并发症。据我们所知，这是首例成功使用利伐沙班治疗OVT的报告。
OVT是一种罕见但可能致命的腹痛原因，可能带来诊断和治疗方面的难题。因子V莱顿（FVL）纯合子是一种不常见但严重的遗传性易栓症，会使血栓形成风险增加约50至80倍。本病例报告及相关文献综述强调了与OVT及遗传性易栓症的诊断和管理相关的重要临床要点。
这一临床案例补充了已发表的文献，表明新型口服抗凝剂，如利伐沙班，最终可能成为维生素K拮抗剂以外治疗轴外血栓形成的替代药物。报告这些病例很重要，因为它们在专业转诊中心以外的患病率较低，因此，传播这些经验可能有助于其他医疗人员治疗他们的患者。
