Apixaban for the treatment of saphenous vein graft thrombosis presenting as unstable angina: a case report

BACKGROUND Saphenous vein graft thrombosis can present as unstable angina. However, percutaneous coronary intervention for saphenous vein graft lesions poses a high risk of slow flow related to the procedure. Here we present the utilization of the novel oral anticoagulant, apixaban, in the treatment of unstable angina with extensive saphenous vein graft thrombus, leading to considerable thrombus resolution and eliminating the need of percutaneous coronary intervention. CASE PRESENTATION A 72-year-old man with 3-vessel coronary artery bypass graft surgery using a saphenous vein graft and a left internal mammary artery, performed 25 years earlier, presented at our hospital with recurrent chest tightness. The echocardiography showed regional hypokinesis of the post-lateral wall with moderate left ventricular dysfunction, which had not been previously confirmed. Coronary angiography showed obstruction of the saphenous vein graft with a large thrombus burden. The left internal mammary artery was patent and other natives were the same as they had been 3 years ago. He was diagnosed with unstable angina due to acute saphenous vein graft thrombosis. Instead of percutaneous coronary intervention, he was treated with apixaban 5 mg twice a day. The angiography 3 weeks after starting apixaban showed considerable resolution of the thrombus and opening of the saphenous vein graft. CONCLUSIONS Apixaban could become a viable treatment option for acute saphenous vein graft thrombosis.