A Case of Rivaroxaban Associated Intracranial Hemorrhage

Overview

Journal West J Emerg Med

Specialty Emergency Medicine

Date 2014 Jul 19

PMID 25035736

Citations 3

Authors

Jean Chin-Yu Lo

Roy R Gerona

Affiliations

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Abstract

Rivaroxaban is a newer anticoagulant initially approved by the Food and Drug Administration to treat nonvalvular atrial fibrillation. Rivaroxaban has several characteristics that are more favorable than warfarin. One of the characteristics is decreased risk of hemorrhage. We report one of the first case reports of severe intracranial hemorrhage associated with rivaroxaban in an elderly patient with decreased renal function. We aim to alert emergency medicine providers regarding the likelihood of encountering these patient as newer anticoagulants rise in popularity.

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References

Helin T, Pakkanen A, Lassila R, Joutsi-Korhonen L . Laboratory assessment of novel oral anticoagulants: method suitability and variability between coagulation laboratories. Clin Chem. 2013; 59(5):807-14. DOI: 10.1373/clinchem.2012.198788. View

Winstanley L, Chen R . New thrombin and factor Xa inhibitors for primary and secondary prevention of ischaemic stroke. CNS Neurol Disord Drug Targets. 2013; 12(2):242-51. DOI: 10.2174/18715273112119990051. View

Bauersachs R, Berkowitz S, Brenner B, Buller H, Decousus H, Gallus A . Oral rivaroxaban for symptomatic venous thromboembolism. N Engl J Med. 2010; 363(26):2499-510. DOI: 10.1056/NEJMoa1007903. View

Kakar P, Watson T, Lip G . Rivaroxaban. Drugs Today (Barc). 2007; 43(3):129-36. DOI: 10.1358/dot.2007.43.3.1067345. View

Hori M, Matsumoto M, Tanahashi N, Momomura S, Uchiyama S, Goto S . Safety and efficacy of adjusted dose of rivaroxaban in Japanese patients with non-valvular atrial fibrillation: subanalysis of J-ROCKET AF for patients with moderate renal impairment. Circ J. 2012; 77(3):632-8. DOI: 10.1253/circj.cj-12-0899. View

Turpie A . New oral anticoagulants in atrial fibrillation. Eur Heart J. 2007; 29(2):155-65. DOI: 10.1093/eurheartj/ehm575. View

Samama M . Use of low-molecular-weight heparins and new anticoagulants in elderly patients with renal impairment. Drugs Aging. 2011; 28(3):177-93. DOI: 10.2165/11586730-000000000-00000. View

Perzborn E, Roehrig S, Straub A, Kubitza D, Mueck W, Laux V . Rivaroxaban: a new oral factor Xa inhibitor. Arterioscler Thromb Vasc Biol. 2010; 30(3):376-81. DOI: 10.1161/ATVBAHA.110.202978. View

Alberts M, Eikelboom J, Hankey G . Antithrombotic therapy for stroke prevention in non-valvular atrial fibrillation. Lancet Neurol. 2012; 11(12):1066-81. DOI: 10.1016/S1474-4422(12)70258-2. View

10.

Kubitza D, Becka M, Voith B, Zuehlsdorf M, Wensing G . Safety, pharmacodynamics, and pharmacokinetics of single doses of BAY 59-7939, an oral, direct factor Xa inhibitor. Clin Pharmacol Ther. 2005; 78(4):412-21. DOI: 10.1016/j.clpt.2005.06.011. View

11.

Prandoni P . Anticoagulant treatment of pulmonary embolism: impact and implications of the EINSTEIN PE study. Eur J Haematol. 2012; 89(4):281-7. DOI: 10.1111/ejh.12002. View

12.

Brem E, Koyfman A, Foran M . Review of recently approved alternatives to anticoagulation with warfarin for emergency clinicians. J Emerg Med. 2013; 45(1):143-9. DOI: 10.1016/j.jemermed.2012.11.032. View

13.

Graff J, Harder S . Anticoagulant therapy with the oral direct factor Xa inhibitors rivaroxaban, apixaban and edoxaban and the thrombin inhibitor dabigatran etexilate in patients with hepatic impairment. Clin Pharmacokinet. 2013; 52(4):243-54. DOI: 10.1007/s40262-013-0034-0. View

14.

Kubitza D, Becka M, Mueck W, Halabi A, Maatouk H, Klause N . Effects of renal impairment on the pharmacokinetics, pharmacodynamics and safety of rivaroxaban, an oral, direct Factor Xa inhibitor. Br J Clin Pharmacol. 2010; 70(5):703-12. PMC: 2997310. DOI: 10.1111/j.1365-2125.2010.03753.x. View

15.

Patel M, Mahaffey K, Garg J, Pan G, Singer D, Hacke W . Rivaroxaban versus warfarin in nonvalvular atrial fibrillation. N Engl J Med. 2011; 365(10):883-91. DOI: 10.1056/NEJMoa1009638. View

16.

Mueck W, Becka M, Kubitza D, Voith B, Zuehlsdorf M . Population model of the pharmacokinetics and pharmacodynamics of rivaroxaban--an oral, direct factor xa inhibitor--in healthy subjects. Int J Clin Pharmacol Ther. 2007; 45(6):335-44. DOI: 10.5414/cpp45335. View

17.

Korber M, Langer E, Ziemer S, Perzborn E, Gericke C, von Heymann C . Measurement and reversal of prophylactic and therapeutic peak levels of rivaroxaban: an in vitro study. Clin Appl Thromb Hemost. 2013; 20(7):735-40. DOI: 10.1177/1076029613494468. View

18.

van Veen J, Smith J, Kitchen S, Makris M . Normal prothrombin time in the presence of therapeutic levels of rivaroxaban. Br J Haematol. 2013; 160(6):859-61. DOI: 10.1111/bjh.12173. View