Apixaban for treatment of venous thromboembolism in an obese patient with Glanzmann thrombasthenia.
apixaban
obesity
recombinant FVIIa
rivaroxaban
thrombasthenia
venous thromboembolism
Journal
Research and practice in thrombosis and haemostasis
ISSN: 2475-0379
Titre abrégé: Res Pract Thromb Haemost
Pays: United States
ID NLM: 101703775
Informations de publication
Date de publication:
May 2023
May 2023
Historique:
received:
19
04
2023
revised:
07
05
2023
accepted:
10
05
2023
medline:
4
8
2023
pubmed:
4
8
2023
entrez:
4
8
2023
Statut:
epublish
Résumé
Glanzmann thrombasthenia (GT) is a rare congenital platelet function disorder associated with a severe bleeding diathesis. Thrombotic manifestations remain a rare condition. We report here the first case of recurrent venous thromboembolism (VTE) successfully treated with apixaban in a patient with GT. Our patient's morbid obesity was an additional challenge. The Key Clinical Question was to determine if direct oral anticoagulants are suitable for patients with both obesity and GT. In our patient, the first episode of VTE occurred after the use of a low dose of activated recombinant factor VII for a minor procedure, whereas the second was unprovoked. Administration of rivaroxaban very quickly led to the appearance of bleeding symptoms and subsequently led to poor compliance and extension of deep vein thrombosis. The patient was switched to apixaban, with very good efficacy and safety over the cumulative 18 months of use. The last updated guidelines now recommend the use of rivaroxaban and apixaban for management of VTE in patients with obesity. Regarding patients with GT, there is still insufficient data on the use of direct oral anticoagulants. Management of thrombotic manifestations in these patients remains a rare and complex condition and could be improved by the creation of a specific international registry.
Sections du résumé
Background
UNASSIGNED
Glanzmann thrombasthenia (GT) is a rare congenital platelet function disorder associated with a severe bleeding diathesis. Thrombotic manifestations remain a rare condition. We report here the first case of recurrent venous thromboembolism (VTE) successfully treated with apixaban in a patient with GT. Our patient's morbid obesity was an additional challenge.
Key Clinical Question
UNASSIGNED
The Key Clinical Question was to determine if direct oral anticoagulants are suitable for patients with both obesity and GT.
Clinical Approach
UNASSIGNED
In our patient, the first episode of VTE occurred after the use of a low dose of activated recombinant factor VII for a minor procedure, whereas the second was unprovoked. Administration of rivaroxaban very quickly led to the appearance of bleeding symptoms and subsequently led to poor compliance and extension of deep vein thrombosis. The patient was switched to apixaban, with very good efficacy and safety over the cumulative 18 months of use.
Conclusion
UNASSIGNED
The last updated guidelines now recommend the use of rivaroxaban and apixaban for management of VTE in patients with obesity. Regarding patients with GT, there is still insufficient data on the use of direct oral anticoagulants. Management of thrombotic manifestations in these patients remains a rare and complex condition and could be improved by the creation of a specific international registry.
Identifiants
pubmed: 37538495
doi: 10.1016/j.rpth.2023.100183
pii: S2475-0379(23)00158-9
pmc: PMC10394540
doi:
Types de publication
Case Reports
Langues
eng
Pagination
100183Informations de copyright
© 2023 The Authors.
Références
Haematologica. 2020 Apr;105(4):888-894
pubmed: 32139434
Blood Rev. 2017 Sep;31(5):287-299
pubmed: 28395882
Ann Intern Med. 2022 Jan;175(1):20-28
pubmed: 34871048
Thromb Res. 2021 Dec;208:39-44
pubmed: 34689080
Clin Case Rep. 2021 Sep 15;9(9):e04757
pubmed: 34552732
PLoS Med. 2013;10(9):e1001515
pubmed: 24068896
Thromb Res. 2020 Aug;192:64-72
pubmed: 32454303
Arch Intern Med. 2009 Mar 23;169(6):610-5
pubmed: 19307525
Lancet Haematol. 2019 Jul;6(7):e359-e365
pubmed: 31133411
Thromb Res. 2020 Dec;196:500-509
pubmed: 33091704
J Thromb Haemost. 2021 Aug;19(8):1874-1882
pubmed: 34259389
Lancet Haematol. 2019 Jan;6(1):e20-e28
pubmed: 30558988
N Engl J Med. 2010 Nov 4;363(19):1791-800
pubmed: 21047223
Res Pract Thromb Haemost. 2021 Aug 01;5(5):e12570
pubmed: 34368613
Br J Haematol. 2018 Sep;182(5):621-632
pubmed: 30117143
Haemophilia. 2013 Nov;19(6):e391-3
pubmed: 23992524
Haematologica. 2015 Aug;100(8):1038-44
pubmed: 26001792