A case of rivaroxaban associated spontaneous hemothorax

Yıldız, İbrahim

doi:10.5606/tgkdc.dergisi.2019.15090

Cited by 4 publications

(3 citation statements)

References 10 publications

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“…The histopathological findings suggested that the preceding infection of the focal bronchiectasis caused the bleeding. Despite the absence of any respiratory symptoms before the onset, she had been at risk both for an infection and bleeding because of stage G3 CKD [3,4] and DOAC administration [5][6][7][8][9][10]. That medical background may have accelerated the bleeding.…”

Section: Discussionmentioning

confidence: 99%

Sudden hemothorax as a rare initial manifestation of bronchiectasis under a direct oral anticoagulant

et al. 2022

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Background A hemothorax as the initial manifestation of bronchiectasis is extremely rare. We report a case of a sudden hemothorax due to exacerbation of clinically latent bronchiectasis under a direct oral anticoagulant. Case presentation A 77-year-old woman presented with chest pain and a fever noted since the day before. She had stage G3 chronic kidney disease and received edoxaban for paroxysmal atrial fibrillation. She had no history of trauma or respiratory symptoms. A chest computed tomography revealed a mass with a surrounding opacity in the right lower lobe with a pleural effusion. Conservative treatment was chosen because of the stable vital signs and her respiratory condition. Her oxygen saturation dropped 7 h later with progressive anemia. Repeated chest computed tomography showed a worsening pulmonary opacity and pleural effusion. She underwent a right lower lobectomy successfully. The histopathological findings suggested that the preceding infection of the subpleural focal bronchiectasis caused the bleeding. In addition, a steep caliber change between the subpleural focal bronchiectasis and proximal normal branch may have caused an intraluminal pressure gradient resulting in a peripheral discharge causing a pleural rupture with a hemothorax. Conclusion The sudden hemothorax could have been the initial manifestation of bronchiectasis. Particular attention should be paid to peripherally localized bronchiectasis even if it is without any clinical symptoms, especially in patients with a comorbidity such as a susceptibility to infections and the use of direct oral anticoagulants.

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Section: Discussionmentioning

confidence: 99%

Sudden hemothorax as a rare initial manifestation of bronchiectasis under a direct oral anticoagulant

et al. 2022

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“…Four case reports were retrieved by inputting "spontaneous hemothorax" and "rivaroxaban" in PubMed (Table 3). [5][6][7][8] The ages of the patients ranged from 24 to 81 years, and three were women older than 60 years of age. The onset of the spontaneous hemothorax varied from 10 days to 4 months after taking rivaroxaban regularly.…”

Section: Discussionmentioning

confidence: 99%

Spontaneous hemothorax caused by concomitant low-dose rivaroxaban and itraconazole in a 95-year-old patient: case report and literature review

Liu

Jiao

2021

J Int Med Res

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Although direct-acting oral anticoagulants (DOACs) decrease the bleeding risk compared with vitamin K antagonists (VKAs), DOACs might cause spontaneous hemothorax in very elderly patients, even at a very low dose. Interactions between drugs might increase the risk of bleeding. In this article, we report a case of a 95-year-old man who developed spontaneous hemothorax while taking rivaroxaban 2.5 mg twice daily, 3 days after concomitant use of itraconazole. Rivaroxaban was discontinued, and thoracentesis was performed to drain grossly bloody pleural effusion. To our knowledge, this is the first case report of spontaneous hemothorax that might have been caused by concomitant low-dose rivaroxaban and azole anti-fungal agents. This case highlights the potential risk of spontaneous hemothorax in very elderly patients while taking rivaroxaban and azole anti-fungal agents simultaneously. Special attention should be paid to interactions between drugs that might increase the risk of bleeding. Drugs that have competing metabolic pathways should be avoided. Closer monitoring, including testing for anti-Xa and additional reassessment, should be considered in high-risk patients.

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“…Treatments for NOAC‐associated spontaneous haemothorax include thoracentesis; drainage with a pleural catheter or large‐bored chest tube; and blood and fluid replacement. For patients with life‐threatening bleeding while taking NOACs, direct reversal agents (eg idarucizumab for dabigatran and andexanet alpha for factor Xa inhibitors) have been suggested .…”

Section: Details Of the Casementioning

confidence: 99%

Spontaneous bilateral haemothorax with haemopericardium secondary to rivaroxaban

Liu

Hsieh

et al. 2020

J Clin Pharm Ther

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What is known and objective Although the risk of major bleeding with non‐vitamin K antagonist oral anticoagulant (NOAC) is low, life‐threatening bleeding can occur. Case summary We report a case of an 81‐year‐old female with deep vein thrombosis who developed bilateral spontaneous haemothorax and haemopericardium after rivaroxaban therapy. Diagnostic thoracentesis revealed a grossly bloody pleural effusion. She was treated with factor eight inhibitor bypassing agent, but the result was not satisfactory. What is new and conclusion To our knowledge, this is the first case report of a concomitant presentation of spontaneous bilateral haemothorax and haemopericardium due to rivaroxaban use. This case highlights the potential risk of major haemorrhagic complication of NOAC, which could be life‐threatening and require emergent reversal.

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A case of rivaroxaban associated spontaneous hemothorax

Cited by 4 publications

References 10 publications

Sudden hemothorax as a rare initial manifestation of bronchiectasis under a direct oral anticoagulant

Sudden hemothorax as a rare initial manifestation of bronchiectasis under a direct oral anticoagulant

Spontaneous hemothorax caused by concomitant low-dose rivaroxaban and itraconazole in a 95-year-old patient: case report and literature review

Spontaneous bilateral haemothorax with haemopericardium secondary to rivaroxaban

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