Case Report: IVC-Agenesis and FVL Mutation; Successful DVT/PE Treatment with Direct Oral Anticoagulation (Factor Xa inhibitor)

Abid Siddiqui ^1* Waris Ali Waris ^2* Tara Hatfield ² Quynh Nguyen ²

• ¹ West Virginia School of Osteopathic Medicine, Lewisburg, West Virginia, United States
• ² Logan Regional Medical Center, Logan, Kansas, United States

Inferior vena cava (IVC) agenesis is a rare congenital condition that has been documented as a primary culprit for unprovoked deep vein thrombosis (DVT) development in as much as 5% of young men under the age of 30. We report a case of a 28-year old obese caucasian male who presented to our hospital with significant pain and swelling in his right lower extremity. Patient stated he had no significant medical history, or family history involving DVT and cardiovascular conditions. Initial diagnostic workup via venous doppler ultrasound revealed an extensive Right Lower Extremity DVT. Upon further investigation, computer tomography (CT) scan imaging of his chest (with pulmonary embolism protocol) and abdomen showed inferior vena cava agenesis with evidence of pulmonary emboli in his left central pulmonary arteries. Hypercoagulable workup was positive for heterozygous Factor V Leiden (FVL) mutation, which is another possible contributing factor to DVT development. Patient was started on an intravenous heparin drip, and later discharged on direct Factor Xa oral anticoagulation. To the best of our knowledge, there have not been any case reports of patients with extensive venous thromboembolisms (VTE) caused by IVC-associated agenesis, and FVL, being treated successfully with direct Factor Xa oral anticoagulation. The objective of this case report is to highlight the complexity of treating patients with multiple risk factors for VTE, and to open a point of discussion as to our decision to have our patient remain on direct factor Xa oral anticoagulation for the remainder of his life.