A Case of Recurrent Deep Vein Thrombosis in an Extremely Elderly Patient Treated with Intermittent Edoxaban

Q: What is the clinical evidence from this study?

Study design: Case Report. Population: Recurrent Deep Vein Thrombosis (n=1). Intervention: Edoxaban. Primary outcome: Recurrence of venous thromboembolism and bleeding complications.

Yosuke Mihara; Naoto Yamamoto; Nozomu Ishikawa; Yusuke Endo; Hajime Tsuyuki; Yuta Yamanaka; Takafumi Kayama; Tatsuro Yata; Kazuto Katahashi; Masaki Sano; Kazunori Inuzuka; Hiroya Takeuchi; Naoki Unno

doi:10.7134/phlebol.25-16

August 12, 2026The Japanese Journal of PhlebologyOpen Access

A Case of Recurrent Deep Vein Thrombosis in an Extremely Elderly Patient Treated with Intermittent Edoxaban

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Key result

Ultra-low-dose intermittent edoxaban prevents recurrent VTE without bleeding in an extremely elderly patient.

n=1

Key Points

To describe the clinical management and feasibility of ultra-low-dose, intermittent edoxaban administration in an extremely elderly patient with recurrent deep vein thrombosis complicated by renal dysfunction and recurrent bleeding.
A female patient in her 90s taking prednisolone developed left proximal deep vein thrombosis (DVT) after a fall.
Treatment was initiated with edoxaban 30 mg/day, interrupted due to gastrointestinal bleeding and anemia (Hb 8.2 g/dL), restarted after prompt recurrence of DVT, and subsequently adjusted downward.
Following repeated bleeding episodes requiring transfusions, an off-label regimen of edoxaban 15 mg administered once every 3 days combined with oral sodium ferrous citrate (50 mg/day) was implemented.
Discontinuation of anticoagulation after 13 months led to symptomatic DVT recurrence within 1 month with D-dimer rising to 21.4 µg/mL.
Resuming edoxaban provoked shoulder hematoma and suspected gastrointestinal bleeding requiring 4 units and subsequently ~10 units of red blood cell transfusions.
Intermittent dosing of edoxaban 15 mg every 3 days with iron supplementation maintained disease control without thrombosis recurrence or transfusion-requiring anemia over 1 year and 7 months of follow-up.

Study Design

Type

Case Report (n=1)

Multicenter

No

Structured PICO

P

Population

A woman in her 90s with recurrent deep vein thrombosis, impaired renal function, and progressive anemia treated with intermittent edoxaban.

I

Intervention

Edoxaban 15 mg oral once every 3 days (intermittent administration) combined with sodium ferrous citrate 50 mg/day.

O

Outcome

Recurrence of venous thromboembolism and progression of anemia requiring blood transfusion.hard clinical

Ultra-low-dose intermittent administration of edoxaban (15 mg once every 3 days) may be a viable therapeutic option for recurrent DVT in extremely elderly patients with high bleeding risk and renal impairment.

Limitations

Single case report
Ultra-low-dose intermittent administration of edoxaban is not a standard treatment and is supported by limited evidence
Underlying malignancy could not be completely ruled out as contrast-enhanced CT or PET-CT were not performed
Not a standard treatment and lacks established evidence
Detailed gastrointestinal screening for malignancy or thrombophilia screening was not performed
D-dimer was used as a factor to stop anticoagulation, which has limitations in predicting recurrence

Implication

Should not change anticoagulation practice; leaves open ultra-low-dose intermittent edoxaban as a last-resort option in highly selected frail elderly.

Abstract

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Discussion

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Cite This Study

Mihara et al. (2026) conducted a case report in Recurrent Deep Vein Thrombosis (n=1). Edoxaban was evaluated on Recurrence of venous thromboembolism and bleeding complications. Ultra-low-dose intermittent administration of edoxaban (15 mg once every three days) successfully prevented recurrent venous thromboembolism without causing bleeding complications in an extremely elderly patient.

synapsesocial.com/papers/6a80199875c2e31742c858b2 https://doi.org/10.7134/phlebol.25-16

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A Case of Recurrent Deep Vein Thrombosis in an Extremely Elderly Patient Treated with Intermittent Edoxaban

Key Points

Study Design

Structured PICO

Limitations

Implication

Abstract

Discussion

Cite This Study

A Case of Recurrent Deep Vein Thrombosis in an Extremely Elderly Patient Treated with Intermittent Edoxaban

Key Points

Study Design

Structured PICO

Limitations

Implication

Abstract

Discussion

Cite This Study

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