Secondary prevention of systemic arterial and recurrent venous thromboembolic events, through extended time anticoagulation with apixaban, in an elderly patient with multiple comorbidities

Abstract

The clinical case illustrates the daily practice with an individualized, adjusted thromboprophylactic dose of apixaban (2.5 mg twice-daily, follow-up for 20 months), mandatory indicated as a continuous therapy for secondary prevention of systemic arterial embolism and recurrent venous thromboembolic events, in an elderly obese patient, associating multiple pathological conditions (chronically anticoagulated for non valvular atrial fibrillation and stroke sequelae, multiple metabolic comorbidities such as type 2 diabetes mellitus , hyperuricemia, moderate renal insufficiency, hyperuricemia), who submitted a severe “unprovoked” phlegmasia alba dolens in the sound (left) lower limb, a decade after a (most possible) iatrogenic deep vein thrombosis at the paralyzed (right) limb. Thromboprophylaxis for an extended time, without any medical complications (neither systemic or venous thrombotic events, nor hemorrhagic ones) confirmed the product`s efficacy and safety profile. Physiopathological considerations and essential pharmacological considerations were discussed, focused on the individualized safe therapeutic approach.