Anaphylaxis following rivaroxaban ingestion: report of an extremely rare case

Abstract

We reported an anaphylactic reaction following ingestion of rivaroxaban in a 48-years-old male, who was recently discharged from the hospital as a case of deep vein thrombosis. At home, the patient developed a diffuse itchy skin rash, shortness of breath, and vomiting 30 minutes after rivaroxaban ingestion. Emergency Medical Service found that the patient had severe dyspnea, low blood pressure, and decreased blood oxygen saturation. The patient was given oxygen, intramuscular epinephrine, intravenous hydrocortisone, diphenhydramine, salbutamol nebulizer, and was immediately transferred to the emergency department of Hamad General Hospital. Subcutaneous enoxaparin was initiated, while hydrocortisone and salbutamol nebulizer continued. On the next day, his vital signs had stabilized, and intravenous hydrocortisone was switched to prednisolone tablets, and salbutamol nebulizer was switched to budesonide/salmeterol inhaler, whereas enoxaparin was overlapped with warfarin. After achieving the target international normalized ratio (INR), enoxaparin was discontinued and the patient was discharged with significant clinical and laboratory improvement.

Suspected Rivaroxaban-Induced Anaphylaxis Secondary to Ingestion of Rivaroxaban and Nimesulide Without Cross-Reactivity to Dabigatran – A Case Report

“…In the case presented here, serum tryptase levels were tested twice, whilst these were not tested in the case reported by Khan and Sulaiman, 2021. 8 This is significant, as serum tryptase test levels were elevated in the patient, confirming the diagnosis.…”

“…In the present case, the patient had previously taken rivaroxaban and had already had allergic episodes in response to rivaroxaban whilst in the case reported by Khan and Sulaiman, 2021, the patient had not previously taken rivaroxaban. 8 In both cases, the time after ingestion of rivaroxaban and before the onset of the symptoms was very short -30 and 10-15 minutes, respectively. In both cases, the symptoms included skin itchiness and shortness of breath.…”

“…32 Khan and Sulaiman, 2021 report that in their presented case, rivaroxabaninduced anaphylaxis is mediated by the IgE-dependent mechanism. 8 In the case of the IgE-dependent mechanism, degranulation of basophils or mast cells is induced by IgE-FcεRI receptor interaction and the resulting intracellular signaling cascade. In the present case, we have observed elevated tryptase level at the time of reaction, thus IgEdependent mechanism with mast cell involvement could be supposed.…”

“…(Table 1). [6][7][8][9][10][11][12][13][14][15][16][17][18][19] Anaphylaxis secondary to rivaroxaban administration, is a rare condition, estimated to occur in about 0.01% of patients. 20 There are few previous cases of this condition in the literature.…”

“…20 There are few previous cases of this condition in the literature. 8 Despite the rarity of the condition, it is essential to consider the possibility of rivaroxaban-induced anaphylaxis when prescribing the drug.…”