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Development of New Deep Venous Thrombosis While on Apixaban

Munish Sharma1, Sabarina Ramanathan1, Koroush Khalighi2

  • 1Department of Internal Medicine, Easton Hospital, Easton, PA, USA.

Case Reports in Cardiology
|July 18, 2017
PubMed

Insights

Novel oral anticoagulants (NOACs) effectively prevent deep venous thrombosis (DVT). This case report details a rare instance of DVT treatment failure in a patient on apixaban for nonvalvular atrial fibrillation (NVAF).

Area of Science:

  • Pharmacology
  • Cardiology
  • Vascular Medicine

Background:

  • Novel oral anticoagulants (NOACs) offer advantages over warfarin for preventing venous thromboembolism (VTE), including predictable pharmacokinetics and reduced monitoring needs.
  • NOACs are generally considered safer and more tolerable due to fewer drug interactions.
  • Despite established efficacy, rare cases of treatment failure can occur, potentially linked to interindividual variations in plasma drug concentrations.

Observation:

  • This report presents a case of a patient experiencing acute deep venous thrombosis (DVT) in the right lower extremity.
  • The patient was undergoing treatment with apixaban, a NOAC, for the prevention of VTE.
  • The underlying condition for VTE prophylaxis was nonvalvular atrial fibrillation (NVAF).

Findings:

  • The patient on apixaban experienced a treatment failure, manifesting as acute DVT.
  • This highlights that even with NOACs, interindividual variability in drug levels can rarely lead to treatment failure.
  • The specific reasons for the elevated plasma drug levels or reduced efficacy in this case were not detailed but are implied.

Implications:

  • This case underscores the importance of considering rare treatment failures with NOACs, even when efficacy is generally high.
  • It suggests that monitoring or assessing factors influencing plasma drug levels might be relevant in specific clinical scenarios.
  • Further research into the causes of interindividual variability in NOAC response is warranted to optimize VTE prevention strategies.

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