Successful Application of Edoxaban in the Treatment of Venous Thromboembolism Recurrence in a Patient with Non-small Cell Lung Cancer after Tumor Shrinkage

Figures

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  Figure 1.. The schedule of treatment and the D-dimer level after the first visit to the previous doctor. During the treatment for venous thromboembolism with warfarin and the first edoxaban treatment, the D-dimer level increased and these treatments seemed to fail. However, during the second edoxaban treatment (after tumor shrinkage was achieved by chemotherapy), the D-dimer level remained within the normal range. Thus, the second application of edoxaban was successful. Computed tomography images of the tumor and pulmonary embolism (CT1 and 2 in Fig. 1) are shown in Fig. 2.

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  Figure 2.. Contrast computed tomography (CT) images. (A) (B) (C) CT was performed on the 34th day after the first visit to the previous doctor, which is indicated by CT1 in Fig. 1. (A) A small primary nodule was detected in the apicoposterior segment of the left lung (black arrow). (B) The mediastinal lymph nodes were enlarged. (C) Pulmonary embolism (PE) in the bilateral pulmonary arteries progressed with anticoagulant treatment with warfarin for approximately 3 weeks. (D) (E) (F) CT was performed on the 118th day after the first visit to the previous doctor, which is indicated by CT2 in Fig. 1. (D) (E) Both the primary nodule and the mediastinal lymphadenopathy shrank after 2 courses of chemotherapy. (F) A regressed PE remained in the left arteria segmentalis basalis anterior (A8) (white arrow) after treatment with intermittent subcutaneous injections of heparin calcium for more than 2 months. After the patient complained of skin irritation from heparin injections, oral edoxaban was retried.