Thrombus Resolution Switching Unfractionated Heparin to Fondaparinux and Edoxaban in Young Patient with Acute Pulmonary Embolism: a case report

Abstract

A 41-year-old female was referred to our department with swelling in her left leg. An ultrasound investigation and computed tomography (CT) imaging revealed an acute deep vein thrombosis (DVT) in the popliteal and superficial femoral veins of her left leg and giant leiomyoma of the uterus. She was initially treated intravenously with unfractionated heparin (UFH) and urokinase. On the 4th day of anticoagulant treatment, the patient presented with massive pulmonary embolism (PE) due to poor anticoagulation response. We switched UFH to fondaparinux (FPX) 7.5 mg subcutaneously once-daily. A CT scan reexamination showed filling defects in the bilateral main pulmonary arteries were remarkably improved after 9 days. After a 14-day course of hospital treatment, she was discharged on oral vitamin K antagonist (VKA) therapy resulted in an international normalized ratio above 1.5. However, she had inadequate international normalized ratio with dyspnea on exertion, and thus, warfarin was switched to non-VKA oral anticoagulant (NOAC) as edoxaban, with significant clinical improvement after 2 weeks of edoxaban treatment. NOACs provide a simplified option and greater convenience compared with traditional anticoagulants. Early and consistent efficacy may be observed in young venous thrombi patients. NOACs may be preferred as a first option for DVT patients with high risk of PE and low risk of hemorrhage.