[MO-43] Treatment of Paget-Schroetter syndrome with direct oral anticoagulant therapy after catheter directed thrombolysis
A 27-year-old man who worked as an automotive engineer visited our hospital with a chief complaint of swelling and left upper arm pain. Chest computed tomography showed non-uniform contrast images corresponding to the site from the left axillary vein to the left subclavian vein. Angiography showed thrombotic obstruction at the same site, leading to a diagnosis of Paget-Schroetter syndrome (PSS). We performed catheter directed thrombolysis (CDT) for 3 days and thrombi were resolved. After CDT therapy, Magnetic Resonance Imaging (MRI) showed elevation of his arm lead to obstruct subclavian vein, while dropping his arm did not cause this obstruction. We performed same examination to a healthy person and this positional change of subclavian obstruction was not detected. In this case, elevation of arms was a risk factor for PSS. However, it was difficult to prevent from elevation of arms due to the characteristics of his job. We started Rivaroxaban 15 mg/day and recurrence of symptom has not occurred for 6 months follow up period.The guidelines for pulmonary thromboembolism due to deep vein thrombosis of the lower limbs indicate that direct oral anticoagulant therapy should be administered for 3 months with no risk factors. In contrast, patients with continuing risk factors, direct oral anticoagulant therapy should be continued as long as the risk factors continue. The treatment for deep vein thrombosis of the lower limbs has been established, while there are no guidelines for treating PSS and few report has referred to efficacy of direct oral anticoagulant therapy on PSS. We report the case of direct oral anticoagulant therapy after catheter directed thrombolysis for the patient with PSS.