Tokyo Rinkai Hospital.
Division of Cardiology, Department of Medicine, Nihon University School of Medicine.
Int Heart J. 2024;65(6):1182-1185. doi: 10.1536/ihj.24-370.
Congenital antithrombin (AT) deficiency is a congenital coagulopathy that predisposes to venous thromboembolism (VTE), although the number of reported patients is limited; thus, large-scale data on the efficacy of direct oral anticoagulants (DOACs) in this population are lacking. There have been case reports of DOAC use in the treatment of VTE in patients with AT deficiency; however, it remains unclear whether rivaroxaban is effective in resolving thrombus and preventing long-term recurrence in pulmonary thromboembolism (PE) associated with massive deep vein thrombosis (DVT). The patient was a 39-year-old man with a family history of thrombosis who presented with lower limb pain and was diagnosed with PE and massive DVT. Continuous treatment with rivaroxaban resulted in a relatively rapid thrombus resolution and no recurrence for 15 months. This case suggests that rivaroxaban may be useful for the treatment and long-term prevention of VTE in patients with AT deficiency with massive thrombosis.
先天性抗凝血酶 (AT) 缺乏症是一种先天性凝血障碍，易发生静脉血栓栓塞症 (VTE)，尽管报告的患者数量有限；因此，缺乏该人群中直接口服抗凝剂 (DOAC) 疗效的大规模数据。有报道称，在 AT 缺乏症患者的 VTE 治疗中使用 DOAC；然而，利伐沙班是否能有效溶解血栓并预防与大量深静脉血栓形成 (DVT) 相关的肺血栓栓塞症 (PE) 的长期复发仍不清楚。该患者是一名 39 岁男性，有血栓形成家族史，下肢疼痛，诊断为 PE 和大量 DVT。连续使用利伐沙班治疗后，血栓相对迅速溶解，15 个月内无复发。该病例提示，利伐沙班可能对 AT 缺乏症合并大量血栓形成的 VTE 患者的治疗和长期预防有效。
