Direct Oral Anticoagulants for Inferior Vena Cava Agenesis

Abstract

Deep vein thrombosis (DVT) is common in the general population, with an annual incidence of 1 to 2 per 1000 people. Inferior vena cava agenesis (IVCA) increased the risk of developing DVT and is found in approximately 5% of young adults (20-40-year-olds) diagnosed with unprovoked proximal DVT. IVCA can be caused by a defective embryological process, or be a result of intrauterine or perinatal thrombosis. Its estimated incidence in the general population ranges from 0.0005% to 1%, usually involving a partial absence of one of the four segments of the inferior vena cava (IVC). The management during the extended phase of patients with DVT associated with IVCA is not yet harmonized, as it is poorly described in the literature. Patients with IVCA are considered to be at high risk of DVT occurrence, prompting physicians to continue extended anticoagulation, often using vitamin K antagonists. In this retrospective study, we present a cohort of 11 patients diagnosed with IVCA following a DVT, who subsequently received extended treatment with a direct oral anticoagulants. These findings offer reassuring insights into the extended utilization of direct oral anticoagulants, demonstrating both antithrombotic efficacy and a favorable safety profile.

Deep venous thrombosis in patients with atresia of the inferior vena cava and right kidney hypoplasia (KILT syndrome): Systematic review of the literature

“…7,46 Although less frequently reported, cases that were successfully treated with long-term DOAC have also been reported. 14,29,35,50 However, no studies have compared the two approaches. Progression or rethrombosis in patients on therapy with both VKA and DOAC has also been reported.…”

“…Although IVC reconstruction is possible, it is only performed in cases where other treatment modalities failed. 16,50 Thrombolysis or thrombectomy can be performed to prevent chronic symptoms, such as residual pain, tenderness, and swelling. It has been shown that patients with IVC anomalies and thrombosis treated with thrombolysis are less likely to develop postthrombotic syndrome or thrombosis recurrence.…”