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Isolated hemopericardium associated with rivaroxaban: first case report
Poojita Shivamurthy1, Navkiran Brar, Michael L Therrien
1Department of Medicine, Saint Francis Hospital and Medical Center, University of Connecticut Health Center, Hartford, Connecticut.
Pharmacotherapy
|July 31, 2014
Summary
Rivaroxaban, a novel anticoagulant, can cause serious bleeding complications like hemopericardium. Clinicians must consider potential drug and herbal interactions to ensure patient safety.
Area of Science:
- Cardiology
- Pharmacology
Background:
- Rivaroxaban is a direct factor Xa inhibitor used for stroke prevention in atrial fibrillation.
- Its activity cannot be monitored using the international normalized ratio (INR).
- Major bleeding events occur in 5.6% of patients, including intracranial and gastrointestinal bleeds.
Observation:
- A 76-year-old male patient on rivaroxaban for atrial fibrillation presented with chest pain and was diagnosed with hemopericardium.
- The patient was also taking saw palmetto, a supplement that may interact with rivaroxaban.
- Other causes of hemopericardium were ruled out.
Findings:
- The patient's hemopericardium was likely related to rivaroxaban use, as indicated by the Naranjo scale (score of 5).
- The bleeding stabilized after discontinuing rivaroxaban, suggesting a probable drug-induced adverse event.
- Saw palmetto may have potentiated the bleeding risk by affecting rivaroxaban metabolism.
Implications:
- This case highlights the risk of rare but life-threatening bleeding complications, such as hemopericardium, with rivaroxaban.
- Clinicians should carefully review all medications, including herbal supplements, for potential interactions that can increase rivaroxaban levels.
- The lack of a specific antidote and inability to dialyze rivaroxaban necessitates vigilant monitoring and awareness of potential adverse events.
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