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2018 ; 2018
(ä): 5217301
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Rivaroxaban Treatment for Warfarin-Refractory Thrombosis in a Patient with
Hereditary Protein S Deficiency
#MMPMID29607227
Ameku K
; Higa M
Case Rep Hematol
2018[]; 2018
(ä): 5217301
PMID29607227
show ga
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.