Acute renal artery thrombosis associated with the use of an oral contraceptive pill

Peripheral, and even visceral, venous thromboembolism is a known complication of oral contraceptive drugs (OCPs) but arterial disease, leading to renal infarction, is rarely reported.  We describe a 36-year-old female patient who presented with sudden left loin pain for 2 days.  Ultrasound examination showed a wedge-shaped echogenic lesion at lateral side of the left kidney.  Computed tomography with contrast showed the area to be avascular and the arteriogram showed abrupt loss of the dorsal branch of left main renal artery, which lacked any deformities, confirming diagnosis of thrombosis-in-situe.  Moreover, the pelvicalyceal system did not show abnormality which ruled out ascending infection.  The patient did not have a family history or laboratory evidence of hypercoagulable disorder. An OCP was the only medication she had received in the previous 3 months. The OCP was discontinued, and the patient was treated with heparin for 3 days then Abixaban for 6 months.  Subsequent CT study with contrast, 3 months later, showed lateral kidney scar.  On follow up; she did not have subsequent thrombotic events up to 1 year.  Keywords: Abixaban, infarction, Kidney, oral contraceptive, thrombosis.