Long-term follow-up after anticoagulant treatment withdrawal in patients with deep venous thrombosis and inferior vena cava agenesis

Riera‐Mestre, Antoni; Romera, Antonio R.; Fernandez, Andrea; Corbella, Xavier

doi:10.1016/j.ejim.2014.10.008

Cited by 13 publications

(9 citation statements)

References 9 publications

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“…On the other hand, other published data reveal that the risk of DVT recurrence after stopping anticoagulation therapy remains low ( 8 ). As reported, the literature remains ambiguous in terms of type and duration of anticoagulation therapy considering the risk of DVT recurrence and the risk of hemorrhagic events.…”

Section: Discussionmentioning

confidence: 99%

Case Report: Inferior Vena Cava Agenesia in a Young Male Patient Presenting With Bilateral Iliac Veins Thrombosis

Pasqui

Donato

Camarri³

et al. 2022

Front. Surg.

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IntroductionAnomalies in inferior vena cava represent an uncommon finding with a prevalence of 0. 3 to 0.5% among healthy patients. Specifically, the condition characterized by the agenesis of the inferior vena cava (IVC; AIVC) has been observed among the 0.0005 to 1% of the general population. AIVC is strongly related to deep vein thrombosis (DVT) of the lower limb and pelvic district, especially in young patients. The rarity of the presented condition could relate to an underestimation of its impact on a particular clinical setting leading to a delayed diagnosis and inaccurate early- and long-term management.ReportWe presented a case of this anomaly regarding a 31-year-old man presenting with bilateral symptomatic proximal DVT. Duplex vascular ultrasound and subsequent CT-angiography revealed the complete occlusion of the right external and common iliac vein, as well as partial occlusion of the contralateral external iliac vein, in the patient. The exam also revealed the interruption of IVC in its infrarenal part. At the level of renal veins coalescence, IVC appeared again in its usual position. A dilatated portal system, hepatic veins, and azygos and hemiazygos systems were also highlighted. Anticoagulation was promptly started with the administration of Fondaparinux (7.5 mg/die). In addition, compression stocking was initiated within 24 h from diagnosis. After 3 weeks, the anticoagulation regimen was shifted toward the administration of a direct oral anticoagulant (Apixaban; 5 mg two times a day). At 1-month follow-up, a vascular duplex ultrasound revealed a complete resolution of the iliac veins' thrombosis.ConclusionIt is important to consider the eventuality of IVC anomalies in a young adult presenting with unexplained, extensive, or bilateral DVT. Accurate diagnostic evaluation is necessary to fully identify this condition that could represent a real challenge.

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Section: Discussionmentioning

confidence: 99%

Case Report: Inferior Vena Cava Agenesia in a Young Male Patient Presenting With Bilateral Iliac Veins Thrombosis

Pasqui

Donato

Camarri³

et al. 2022

Front. Surg.

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“…Lifelong anticoagulation has been advocated on the basis that IVC anomalies represent a ‘permanent’ risk factor, and associated thromboembolic events can result in significant acute and chronic morbidity [5]. However, it has been demonstrated that the risk of DVT recurrence and PTS in patients with isolated IVC anomalies and no additional risk factors are no higher than in the general population [6]. Thus, many authors are now suggesting that, in the absence of other risk factors, a shorter treatment with a duration of 3–6 months is sufficient.…”

Section: Discussionmentioning

confidence: 99%

An unusual case of deep venous thrombosis in a young patient: congenital absence of the infrarenal portion of the inferior vena cava

Osborne

Sheehan

2019

Oxford Medical Case Reports

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Deep venous thrombosis (DVT) is a commonly encountered diagnosis in clinical practice with a variety of well-established risk factors. Congenital absence of the inferior vena cava (IVC) is an extremely rare but established risk factor for DVT. Patients who develop DVTs are at high risk of long-term complications, including DVT recurrence and post-thrombotic syndrome. Here we report a rare case of a 27-year-old female who presented with an extensive DVT of the right lower extremity secondary to complete absence of the infrarenal portion of the IVC, confirmed on computed tomography. There is little consensus regarding the appropriate management of this patient population, and a brief review of the current evidence follows.

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“…8 Patients are generally advised to maintain anticoagulation for at least three months following DVT to avoid early recurrence. Nevertheless, maintenance of lifelong anticoagulation is controversial and has been recently challenged by the finding that patients with IVC anomalies do not seem to have a higher risk of DVT recurrence after withdrawal of anticoagulant 14 ; even so, many authors still support long-term anticoagulation, particularly if additional risk factors for thrombosis are present. 12 Nonpharmacologic and universally recommended preventive measures include use of compression stockings and lifestyle adjustment for reducing the bleeding risk while under anticoagulation therapy.…”

Section: Discussionmentioning

confidence: 99%

“…7 Other clues for the diagnosis of IVC anomalies include enlargement of the azygous vein on chest radiography (due to collateral venous return), presence of abdominal collateral circulation on clinical examination, severe venous insufficiency at a young age, and male gender. 14,15 Although less commonly, complete or partial agenesis of the IVC may also present concomitantly with other organ abnormalities, such as congenital heart defects (dextrocardia, septal defects, pulmonary artery stenosis, single atrium, and transposition of great vessels), polysplenia, asplenia, inversion of bowel viscera, and kidney hypoplasia. 15,16 The impact of IVC agenesis in the long-term prognosis of DVT is still unclear.…”

Section: Discussionmentioning

confidence: 99%

Bilateral Deep Vein Thrombosis Associated with Inferior Vena Cava Agenesis in a Young Patient Manifesting as Low Back Pain

et al. 2017

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Congenital absence of the inferior vena cava is a rare vascular anomaly, and most cases are asymptomatic. Nevertheless, patients with inferior vena cava malformations may have increased risk of deep venous thrombosis. Particularly, cases of bilateral deep venous thrombosis may arise owing to an insufficient collateral venous drainage from the lower limbs. We hereby describe a case of a previously healthy young male patient presenting with bilateral lower limb deep venous thrombosis as the initial clinical manifestation of congenital inferior vena cava agenesis. We conclude that in young patients presenting with deep venous thrombosis, especially when thrombosis occurs spontaneously, bilaterally, or recurrently, inferior vena cava anomalies should be thoroughly investigated and ruled out as appropriate.

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Long-term follow-up after anticoagulant treatment withdrawal in patients with deep venous thrombosis and inferior vena cava agenesis

Cited by 13 publications

References 9 publications

Case Report: Inferior Vena Cava Agenesia in a Young Male Patient Presenting With Bilateral Iliac Veins Thrombosis

Case Report: Inferior Vena Cava Agenesia in a Young Male Patient Presenting With Bilateral Iliac Veins Thrombosis

An unusual case of deep venous thrombosis in a young patient: congenital absence of the infrarenal portion of the inferior vena cava

Bilateral Deep Vein Thrombosis Associated with Inferior Vena Cava Agenesis in a Young Patient Manifesting as Low Back Pain

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