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Antiphospholipid syndrome presenting as acute mesenteric venous thrombosis involving a variant inferior mesenteric vein and successful treatment with rivaroxaban
  1. Kevin Singh1,
  2. Gulam Khan2
  1. 1Department of Medicine, New York University School of Medicine, Woodhull Medical Center, Brooklyn, New York, USA
  2. 2Department of Gastroenterology, New York University School of Medicine, Woodhull Medical Center, Brooklyn, New York, USA
  1. Correspondence to Dr Kevin Singh, Singh.kevin{at}


Acute mesenteric venous thrombosis (MVT) is the rarest cause of acute mesenteric ischaemia, so thrombosis of a variant inferior mesenteric vein (IMV) is especially uncommon in the setting of antiphospholipid syndrome (APS). Here, we present such a case of seronegative APS initially manifesting as an anomalous IMV thrombosis in a 76-year-old woman. Although guidelines support anticoagulation with vitamin K antagonists in these patients, we anticoagulated with rivaroxaban (a direct oral anticoagulant (DOAC)) due to patient preference, which resulted in complete clinical and endoscopic resolution. IMV thrombosis is a rare form of MVT, only two case reports describe successful anticoagulation with DOACs in the setting of MVT and none report APS as an underlying aetiology. Therefore, this case provides the opportunity to review the pathophysiology of MVT, APS and their medical management including current trends in anticoagulation.

  • gastroenterology
  • gastrointestinal system
  • GI bleeding
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  • Contributors KS and GK both were involved in patient care of this patient. KS wrote this manuscript. GK proofread this manuscript.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient consent Obtained.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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