Paget-Schroetter syndrome (PSS) is a rare syndrome that typically develops in young, healthy males subjected to repetitive overhead motions resulting in compression and
thrombosis of the subclavian vein. This "effort
thrombosis" typically occurs acutely in patients with specific anatomic variations within the thoracic outlet and is treated by a combination of surgical and pharmacologic interventions. There is a paucity of literature regarding this syndrome, particularly surrounding
pharmacotherapy, and in the treatment of pediatric patients. This case report documents the pharmacologic treatment of a 17-year-old, male, baseball player with confirmed PSS.
Apixaban was selected as the
anticoagulant therapy of choice following the determination of its safety and anticipated efficacy for this pediatric patient. Upon admission, anticoagulation was initiated with intravenous
heparin and transitioned to
warfarin for 1 dose. On day 2, the patient was discharged with
apixaban 10 mg twice daily for 7 days, followed by 5 mg twice daily. One week later, he underwent
catheter-directed
thrombectomy, followed by thoracic outlet
decompression with resection of the first rib.
Apixaban therapy was continued for 10 weeks after the procedure to diminish the risk of any further thrombotic events. This pediatric patient with PSS was successfully treated with
apixaban in conjunction with surgical management. Treatment with
apixaban resulted in continued resolution of
thrombus after follow-up, with no complications reported thereafter. Further research is needed to definitively determine the safety and efficacy of
apixaban for the use of pediatric anticoagulation, particularly in
upper extremity deep vein thrombosis.