Treatment of Deep Vein Thrombosis in May-Thurner's Syndrome with a Novel Oral Anticoagulant: A Case Report

May-Thurner's syndrome (MTS) is an anatomical variant where the left common iliac vein (CIV) is compressed by the overlying right common iliac artery and the underlying lumbar vertebrae, leading to stenosis in the left CIV. Endovascular intervention followed by anticoagulation currently constitute the mainstay of management of MTS associated with recurrent deep vein thrombosis (DVT). Warfarin appears to be the anticoagulant of choice in most studies conducted in patients with MTS. There is little evidence of treatment using nonvitamin K oral anticoagulants. This case report serves to describe a patient with MTS who was successfully treated with catheter-directed therapy followed by anticoagulation using rivaroxaban. A 64-year-old women presented with left lower limb swelling. Her duplex ultrasound and computed tomography (CT) showed extensive DVT and underlying narrowing of the left CIV, respectively. She underwent catheter-directed therapy, involving stent placement in the left CIV, and was subsequently started on rivaroxaban. She developed partial thrombosis of the external iliac vein at 5 months postprocedure and partial stent thrombosis at 1 year postprocedure while on rivaroxaban, requiring repeat stenting and continuation of anticoagulation. On follow-up, there was no recurrence of symptoms related to MTS, no postthrombotic syndrome, and no clinically significant bleeding as a side effect of rivaroxaban. This case report shows that rivaroxaban is a safe agent that can be successfully used in the treatment of MTS after stenting.