Renal Vein Thrombosis Treated With Apixaban in a Patient With COVID-19: A Case Report

Abstract

Renal vein thrombosis (RVT) is a rare condition characterized by the formation of a blood clot in one or both of the renal veins. Bilateral involvement is more common, but when the condition affects only one side, it usually occurs on the left due to more extensive venous vasculature compared to the right side. RVT can be caused by various factors such as trauma, dehydration, malignancy, and a hypercoagulable state. Acute RVT is typically more severe than chronic, and it can cause symptoms such as renal infarction, acute kidney injury, renal failure, severe flank pain, and hematuria. Some cases of RVT have also been linked to coronavirus disease 2019 (COVID-19), which is widely recognized to induce a hypercoagulable state. The standard treatment for RVT is warfarin but in this case report, we describe a COVID-19 patient with RVT whose thrombus was successfully treated with direct-acting oral anticoagulant (DOAC) apixaban for six months.

A Rare Case of Renal Vein Thrombosis Secondary to Oral Contraceptive Pills

“…Apart from OCPs, other risk factors for RVT include infection, trauma, extrarenal compression of the renal vein, and, most recently, SARS-CoV-2 [2]. OCPs affect blood clotting by increasing plasma fibrinogen levels and increasing the activity of factors VII and X.…”

Renal Vein Thrombosis Secondary to Pyelonephritis: Targeting a Thrombo-Inflammatory Entity

“…However, contemporary practice leans towards conservative management consisting of anticoagulation therapy with a transition from LMWH to vitamin K antagonists [ 45 ]. Limited data are available on the use of direct thrombin inhibitors (e.g., dabigatran and argatroban) and factor Xa inhibitors (e.g., rivaroxaban, apixaban, and fondaparinux) in patients with RVT, so their administration remains controversial [ 46 , 47 , 48 , 49 , 50 , 51 , 52 ]. However, there has recently been an increasing number of reports advocating their use among patients with RVT [ 46 , 47 , 48 , 49 , 50 , 51 , 52 ].…”

“…Limited data are available on the use of direct thrombin inhibitors (e.g., dabigatran and argatroban) and factor Xa inhibitors (e.g., rivaroxaban, apixaban, and fondaparinux) in patients with RVT, so their administration remains controversial [ 46 , 47 , 48 , 49 , 50 , 51 , 52 ]. However, there has recently been an increasing number of reports advocating their use among patients with RVT [ 46 , 47 , 48 , 49 , 50 , 51 , 52 ]. In general, there are many reports supporting their use even in cases of deep venous thrombosis of atypical locations [ 50 , 51 , 52 ].…”