Rivaroxaban Treatment for Warfarin-Refractory Thrombosis in a Patient with Hereditary Protein S Deficiency.
Rivaroxaban Treatment for Warfarin-Refractory Thrombosis in a Patient with Hereditary Protein S Deficiency.
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DOI：
10.1155/2018/5217301
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发表时间：
2018
影响因子：
0.7
通讯作者：
Higa M
中科院分区：
文献类型：
--
作者：
Ameku K;Higa M
蛋白S缺乏症是一种常染色体显性遗传性血栓形成症，在东亚人群中比在高加索人群中更常见。PS缺乏的患者历来接受肝素产品和华法林治疗和二级预防静脉血栓栓塞症(VTE)。然而，在极少数情况下，华法林可能无效或造成有害影响。虽然直接口服抗凝剂(DOAC)被越来越多地用于治疗和预防VTE，但其对PS缺乏患者的疗效尚未确定。我们描述一位91岁的女性，出现慢性双侧小腿肿胀合并静脉血栓栓塞症，对华法林抗凝治疗无效超过1年。她的复发性VTE被诊断为数量遗传性PS缺乏症。用利伐沙班替代华法林作为维持治疗；8周后，与华法林相比，利伐沙班可显著减轻患者腿部肿胀和静脉溃疡的严重程度，从而证明利伐沙班对与遗传性PS缺乏相关的华法林难治性慢性VTE的疗效。这一案例说明利伐沙班有可能作为治疗药物来治疗PS缺乏患者的华法林难治性VTE。需要进一步的研究来证实利伐沙班在这方面的长期疗效。
Protein S (PS) deficiency, an autosomal dominant hereditary thrombophilia, is more prevalent in East Asian populations than in Caucasians. PS-deficient patients have historically been administered a heparin product followed by warfarin for the treatment and secondary prevention of venous thromboembolism (VTE). However, warfarin can be ineffective or causes detrimental effects in rare cases. While direct oral anticoagulants (DOACs) are being increasingly used for the treatment and prevention of VTE, their efficacy in PS-deficient patients has not been established. We describe a 91-year-old woman who presented with chronic bilateral lower leg swelling with VTE that was refractory to warfarin anticoagulation therapy for over 1 year. Her recurrent VTE was diagnosed as quantitative hereditary PS deficiency. Rivaroxaban was administered as maintenance therapy instead of warfarin; after 8 weeks, the severities of the patient's leg swelling and venous ulcerations were significantly reduced with rivaroxaban compared to warfarin, thus demonstrating the efficacy of rivaroxaban for warfarin-refractory chronic VTE associated with hereditary PS deficiency. This case illustrates that rivaroxaban can potentially serve as therapeutic agents to treat warfarin-refractory VTE in PS-deficient patients. Further investigations are required to confirm the efficacy of rivaroxaban on the long term in this regard.