Singh Kevin, Khan Gulam
Department of Medicine, New York University School of Medicine, Woodhull Medical Center, Brooklyn, New York, USA.
Department of Gastroenterology, New York University School of Medicine, Woodhull Medical Center, Brooklyn, New York, USA.
BMJ Case Rep. 2018 Mar 26;2018:bcr-2017-223077. doi: 10.1136/bcr-2017-223077.
Acute mesenteric venous thrombosis (MVT) is the rarest cause of acute mesenteric ischaemia, so thrombosis of a variant inferior mesenteric vein (IMV) is especially uncommon in the setting of antiphospholipid syndrome (APS). Here, we present such a case of seronegative APS initially manifesting as an anomalous IMV thrombosis in a 76-year-old woman. Although guidelines support anticoagulation with vitamin K antagonists in these patients, we anticoagulated with rivaroxaban (a direct oral anticoagulant (DOAC)) due to patient preference, which resulted in complete clinical and endoscopic resolution. IMV thrombosis is a rare form of MVT, only two case reports describe successful anticoagulation with DOACs in the setting of MVT and none report APS as an underlying aetiology. Therefore, this case provides the opportunity to review the pathophysiology of MVT, APS and their medical management including current trends in anticoagulation.
急性肠系膜静脉血栓形成（MVT）是急性肠系膜缺血最罕见的病因，因此在抗磷脂综合征（APS）背景下，肠系膜下静脉（IMV）变异型血栓形成尤为罕见。在此，我们报告一例血清学阴性APS病例，最初表现为一名76岁女性的IMV异常血栓形成。尽管指南支持在这些患者中使用维生素K拮抗剂进行抗凝治疗，但由于患者偏好，我们使用利伐沙班（一种直接口服抗凝剂（DOAC））进行抗凝，结果临床和内镜检查均完全缓解。IMV血栓形成是MVT的一种罕见形式，仅有两篇病例报告描述了在MVT背景下使用DOAC成功抗凝的情况，且均未报告APS为潜在病因。因此，本病例为回顾MVT、APS的病理生理学及其药物治疗（包括当前抗凝趋势）提供了机会。
