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Pylephlebitis treated with apixaban

Graham R Hale1, Leon Alan Sakkal2, Taki Galanis3

  • 1Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA, USA.

Hospital Practice (1995)
|September 24, 2019
PubMed

Insights

Pylephlebitis, a rare infected portal vein thrombus, was successfully treated in a 77-year-old male with splenic abscess and bacteremia. This case highlights the use of apixaban, a direct oral anticoagulant, in managing this serious condition.

Area of Science:

  • Internal Medicine
  • Infectious Diseases
  • Vascular Surgery

Background:

  • Pylephlebitis, an infected thrombus of the portal venous system, historically carries a high mortality rate.
  • The advent of antibiotics significantly improved outcomes, but management remains challenging.
  • Prompt diagnosis and multimodal treatment are crucial for patient survival.

Observation:

  • A 77-year-old male presented with splenic vein thrombosis, Parvimonas micra bacteremia, and a polymicrobial splenic abscess.
  • The patient underwent successful splenic abscess drainage.
  • A six-week course of intravenous antibiotics was administered.

Findings:

  • The patient received apixaban, a direct oral anticoagulant, at 2.5 mg twice daily for anticoagulation.
  • This represents the second documented case of pylephlebitis treated with apixaban.
  • The combination of abscess drainage, antibiotics, and anticoagulation led to a favorable outcome.

Implications:

  • This case suggests that direct oral anticoagulants like apixaban may be a viable treatment option for pylephlebitis.
  • Further research is warranted to establish the safety and efficacy of DOACs in managing pylephlebitis.
  • Successful management underscores the importance of a multidisciplinary approach in treating complex infectious-thrombotic conditions.
Keywords:
Pylephlebitisanticoagulantapixabanparvinomonassplenic veinthrombosis

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