Alveolar Hemorrhage Associated with Rivaroxaban: A Case Series

Laird-Fick, Heather; Grondahl, Brian; Benedict, Megan; Riehani, Anas

doi:10.4172/2161-105x.1000405

Cited by 3 publications

(3 citation statements)

References 12 publications

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“…The subsequent disruption of the alveolar-capillary basement membrane caused bleeding into the alveolar spaces in the setting of long-term anticoagulation therapy. Rivaroxaban-associated alveolar hemorrhage is also rare, and no definitive evidence of a direct causative relationship has been established [17]. In our case, rivaroxaban was started nine years ago, which is unlikely to cause the recent hemorrhage.…”

Section: Discussionmentioning

confidence: 61%

Diffuse Alveolar Hemorrhage With Avelumab Maintenance Therapy

Sharma

Kazmierski

et al. 2021

Cureus

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Immune checkpoint blockade is a rapidly expanding therapeutic modality in oncology. However, its adverse effects extend beyond the cytotoxicity of conventional chemotherapy. Pneumotoxicity associated with immune checkpoint therapy presents a diagnostic conundrum that has been further complicated by the COVID-19 pandemic. We report a case of a patient with metastatic urothelial carcinoma who developed diffuse alveolar hemorrhage (DAH) following treatment with avelumab.

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Section: Discussionmentioning

confidence: 61%

Diffuse Alveolar Hemorrhage With Avelumab Maintenance Therapy

Sharma

Kazmierski

et al. 2021

Cureus

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“…There are only a few cases reported in the literature. 3 Patients usually present with cough, dyspnea, and hemoptysis and have lung infiltrates or diffuse ground-glass opacities. Although our patient could have just had rivaroxaban-associated DAH, the purpuric lower extremity lesions, the joint swelling, the positive ANCA test, and the biopsy were concerning for drug reaction, and made drug-associated AAV the most likely diagnosis.…”

Section: Discussionmentioning

confidence: 99%

Late Onset of Rivaroxaban-Associated Anti-Neutrophil Cytoplasmic Antibody–Associated Vasculitis

Agarwal,

Cummings,

Larsen

et al. 2023

Journal of Investigative Medicine High Impact Case Reports

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Although anti-thyroid drugs (ATDs) are the most common cause of drug-associated anti-neutrophil cytoplasmic antibody (ANCA) vasculitis (AAV), many other classes of drugs can lead to drug-associated AAV. We present a unique case of rivaroxaban-associated AAV. A 76-year-old female with a past medical history of atrial fibrillation on rivaroxaban presented with fatigue, bilateral lower extremity purpura, and hemoptysis to an outside hospital. Investigations revealed a positive cytoplasmic-ANCA (c-ANCA) titer of 1:320 and a positive anti-myeloperoxidase (anti-MPO), and negative perinuclear-ANCA (p-ANCA) and anti-proteinase 3 (anti-PR3). In addition, chest imaging demonstrated bilateral ground-glass opacities which raised suspicion for diffuse alveolar hemorrhage (DAH). A lung biopsy revealed acute and ongoing DAH with focally active capillaritis and characteristic pathological findings, which strongly suggested that was likely secondary to rivaroxaban. Rivaroxaban was discontinued, and the patient received pulses of intravenous glucocorticosteroids and rituximab. Her symptoms improved. She continued immunosuppressive therapy with rituximab for 2 years. She presented to our hospital for a second opinion regarding the discontinuation of rituximab, and we decided to discontinue rituximab. After discontinuation, the patient remained stable after 1.5 years of follow-up and did not have any relapses. This is a unique case of rivaroxaban-associated AAV. Clinicians should consider drug-associated AAV in all patients who present with an atypical clinical presentation and/or pathological findings of AAV. Given the broad and rapidly increasing use of novel anticoagulants, it is important to raise awareness of this potential complication. Prompt discontinuation of the drug and initiation of immunosuppressant treatment in severe cases may be lifesaving.

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“…[71][72][73] A case series identified the incidence of rivaroxaban associated with significant alveolar hemorrhage to be 3 in 1,000 patients. 74 Several factors may be contributing to warfarin-induced hemoptysis. Underlying severe mitral valve stenosis, heart failure, variable therapeutic levels due to dosing, and dietary interactions can lead to an increased risk of bland alveolar hemorrhage.…”

Section: Ac-induced Lthmentioning

confidence: 99%

Life-Threatening Hemoptysis

Deshwal

Sinha

Mehta

2020

Semin Respir Crit Care Med

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Life-threatening hemoptysis (LTH) is any amount of hemoptysis that causes significant hemodynamic decompensation or respiratory distress which may lead to death if left untreated. While the amount of hemoptysis that qualifies as massive hemoptysis has continued to be debated, any amount between 100 to 1,000 mL/day is considered significant. Up to 15% cases of hemoptysis are LTH and need urgent life-saving intervention. Understanding of pulmonary vascular anatomy is of paramount importance to manage LTH. The goal of treatment lies in airway protection, appropriate oxygenation, and prevention of exsanguination. Once the airway is stabilized, a quick diagnosis and control of bleeding site is targeted. This chapter highlights current practices and approach to LTH including medical management, bronchoscopic approach, and advanced therapies such as bronchial artery embolization and surgical resection. We review situations, such as bronchiectasis, vascular malformation, diffuse alveolar hemorrhage, and tracheostomy bleed and specific approach to management of these conditions in a systematic and evidence-based manner.

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Alveolar Hemorrhage Associated with Rivaroxaban: A Case Series

Cited by 3 publications

References 12 publications

Diffuse Alveolar Hemorrhage With Avelumab Maintenance Therapy

Diffuse Alveolar Hemorrhage With Avelumab Maintenance Therapy

Late Onset of Rivaroxaban-Associated Anti-Neutrophil Cytoplasmic Antibody–Associated Vasculitis

Life-Threatening Hemoptysis

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