Drug-induced thrombocytopenia after anticoagulation with rivaroxaban

Pop, Marianne; Farokhi, Farhad; Iduna, Lela

doi:10.1016/j.ajem.2017.12.052

Cited by 13 publications

(6 citation statements)

References 8 publications

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“…A possible antibody-dependent mechanism may be postulated (12), in which the drug, by binding reversibly to platelet membrane proteins, induces structural changes in the membrane proteins resulting in new antigen exposure. Delayed-onset thrombocytopenia was associated with purpuric lesions 4 months after starting rivaroxaban therapy, which gradually resolved six days after discontinuation (13). Of note, a 3-day course of high dose intravenous immunoglobulins probably contributed to rapid improvement of platelet count.…”

Section: Resultsmentioning

confidence: 98%

Hypersensitivity reactions to non-vitamin K oral anticoagulants - a review of literature and diagnostic work-up proposal

Carli

Farsi

Chiarini

et al. 2019

Eur Ann Allergy Clin Immunol

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Non-vitamin K antagonist oral anticoagulants (NOACs) are increasingly being used in hospital and outpatient settings as safe alternatives to warfarin. Hypersensitivity reactions have been described for NOACs and can be classified according to Gell and Coombs. We reviewed case reports of possible drug hypersensitivity reactions, noticing a predominance of delayed reactions (both mild and severe) and the absence of cross-reactions to warfarin and low molecular weight heparins. International experience on diagnostic tests is lacking. The vast majority of authors refer to probability scores and rely on biopsy to classify vasculitis and rule out differential diagnoses. We propose to adapt available tests to confirm the patient's reactivity to new anticoagulants. Among in vivo tests, patch testing revealed promising in delayed reactions.

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Section: Resultsmentioning

confidence: 98%

Hypersensitivity reactions to non-vitamin K oral anticoagulants - a review of literature and diagnostic work-up proposal

Carli

Farsi

Chiarini

et al. 2019

Eur Ann Allergy Clin Immunol

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“…ISN 2707-2207 / ISSN 2707-2215 (en línea), mayo-junio, 2022, Volumen 6, Número 3 p 4642 hemorragia gastrointestinal y luego comenzó con rivaroxabán para la fibrilación (Pop, Farokhi, & Iduna, 2018).…”

Section: Resultados Y Discusiónunclassified

Purpura de henoch scholein relacionada con uso de rivaroxaban un evento adverso infrecuente y de mecanismos aun desconocidos, descripcion de un caso

león

Sarmiento²,

Robles³

et al. 2022

Ciencia Latina

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Introduction: Rivaroxaban is a novel direct-acting oral anticoagulant (DOAC) that is used both for the treatment and prevention of thromboembolic diseases. Due to the mechanism of action; the most common side effect can be seen with bleeding. Here we report that a patient with deep vein thrombosis of the lower limbs who presented Henoch Scholein Purpura while taking rivaroxaban. Clinical case: Female patient of the VII decade of life, was administered rivaroxaban, after intolerance to warfarin. On day 4 of the first week of treatment, the patient was admitted to the emergency department with bleeding from the oral mucosa and petechial spots. The patient was diagnosed with Henoch Scholein Purpura due to the use of rivaroxaban, after ruling out most of the possibilities. After stopping rivaroxaban treatment, the patient's bleeding symptoms subsided, the symptoms resolved completely, and her petechiae disappeared. The patient is controlled after the omission of the treatment and completely resolved the clinical picture. Conclusion: So far there are very few reports of this type when taking direct oral anticoagulants. In addition to the known side effects of rivaroxaban treatment, it should be noted that thrombocytopenia may also develop. The Naranjo scale of probability of adverse drug reaction calculated was 7 points. (probable cause of the patient's Purpura).

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“…9 cases of the 11 occurred following dabigatran therapy, and 2 cases occurred after rivaroxaban therapy. [18][19][20][21] None of these case reports provided a possible explanation or pathophysiological mechanism by which DOACs could cause thrombocytopenia.…”

Section: Discussionmentioning

confidence: 97%

Lijekovima uzrokovana imuna trombocitopenija – prikaz bolesnice

Korać,

Juranec,

Delalić

et al. 2024

Med. Jadert. (Online)

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Thrombocytopenia is defined as a reduced platelet count. Drug-induced immune thrombocytopenia (DITP) is a condition mediated by antibodies developed following the ingestion of a certain medication. A sudden drop in platelet count accompanied by ecchymosis, petechiae, and mucosal bleeding following the introduction of a new medication should raise suspicion for DITP. This case report describes the case of a 76-year-old female patient who first appeared at the Emergency Department (ED) with symptoms related to heart failure and atrial fibrillation. The patient was taking warfarin as an anticoagulant therapy when she presented herself to the ED. Following a short hospitalization at the Cardiology Department, the patient was discharged home with dabigatran instead of warfarin as the anticoagulant therapy. After several days of taking dabigatran, the patient came to the ED with a chief complaint of dark-colored urine. Her platelet count (measured using a machine and manually counted) was 13×109/L, and the urinalysis was positive for microhematuria. Dabigatran was excluded from the patient’s medication list. At a later date, following the patient’s request, she started with rivaroxaban prescribed by her general practitioner. The test for anti-platelet IgG antibodies (performed while the patient was taking dabigatran and later rivaroxaban) was positive. Therefore, rivaroxaban was also excluded from the patient’s medication list. After the platelet count normalized, warfarin was reinstituted into the patient's therapy. Due to the diagnosis of DITP being most often empirical, clinicians should suspect DITP if there is a sudden drop in the platelet count accompanied by signs of bleeding following the introduction of a new medication in the patient’s therapy. Additional laboratory workup for transfusion reactions should be conducted, while the culprit medication should be excluded from the patient’s medication list without delay.

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Drug-induced thrombocytopenia after anticoagulation with rivaroxaban

Cited by 13 publications

References 8 publications

Hypersensitivity reactions to non-vitamin K oral anticoagulants - a review of literature and diagnostic work-up proposal

Hypersensitivity reactions to non-vitamin K oral anticoagulants - a review of literature and diagnostic work-up proposal

Purpura de henoch scholein relacionada con uso de rivaroxaban un evento adverso infrecuente y de mecanismos aun desconocidos, descripcion de un caso

Lijekovima uzrokovana imuna trombocitopenija – prikaz bolesnice

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