Efficacy of direct oral anticoagulant for renal infarction due to pulmonary vein stump thrombosis after left pneumonectomy

Surgical Case Reports

Case Report

Nozomu Motono¹  Yoshihito Iijima¹  Hidetaka Uramoto¹  Shun Iwai¹ 

[1] Department of Thoracic Surgery, Kanazawa Medical University, 1-1 Daigaku, Kahoku-Gun, 920-0293, Uchinada-Machi, Ishikawa, Japan;

关键词: Lung cancer;    Pneumonectomy;    Pulmonary vein stump thrombosis;    Renal infarction;    Direct oral anticoagulant;   

DOI  :  10.1186/s40792-022-01574-8

 received in 2022-10-05, accepted in 2022-11-26,  发布年份 2022

来源: Springer

【 摘 要 】

BackgroundThrombosis of the pulmonary vein stump is a common complication after a left upper lobectomy and can be a source of embolism in various organs, such as the kidneys. A renal infarction, on the other hand, is a rare and often lethal condition that is usually diagnosed postmortem. Here, we present a case of renal infarction associated with pulmonary vein stump thrombosis after a left pneumonectomy, which was treated successfully with edoxaban.Case presentationA 73-year-old man was diagnosed with squamous cell lung cancer (cT1miN0M0 stage IA1). Due to pneumoconiosis, extensive lymph node infiltration into the pulmonary artery was noted and necessitated an open thoracotomy. Ultimately, a left pneumonectomy was performed. Atrial fibrillation occurred on postoperative day 3, and the patient complained of left-sided abdominal pain. Contrast-enhanced computed tomography revealed a left upper pulmonary vein thrombosis and a left renal infarction. Anticoagulant therapy was immediately initiated with heparin and warfarin. On postoperative day 13, warfarin was replaced with the direct oral anticoagulant edoxaban since the patient’s compliance and drug response to warfarin were poor. On postoperative day 19, contrast-enhanced computed tomography revealed a reduction in pulmonary vein stump thrombosis and improvement in renal infarction. Subsequently, the patient was discharged. Three months post-surgery, no infarct lesions or reduced renal function was observed on imaging.ConclusionsThe direct oral anticoagulant edoxaban could be effective in preventing recurrence or exacerbation of pulmonary vein thrombosis associated with renal infarction without bleeding complications.

【 授权许可】

CC BY   
© The Author(s) 2022

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