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Possible Rivaroxaban Failure during the Postpartum Period.

Kelly M Rudd1, Amanda R McFee Winans1, Narmadha Panneerselvam2

  • 1Section of Clinical Pharmacy, Department of Pharmaceutical Care Services, Bassett Medical Center, Cooperstown, New York.

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|November 25, 2015
PubMed
Summary
This summary is machine-generated.

Direct-acting oral anticoagulants (DOACs) like rivaroxaban may be less effective in the postpartum period due to physiological changes. This case highlights potential rivaroxaban failure in a postpartum patient with deep vein thrombosis and pulmonary embolism.

Keywords:
anticoagulationdirect-acting oral anticoagulantpharmacokineticspostpartumpregnancy

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Area of Science:

  • Pharmacology
  • Obstetrics
  • Hematology

Background:

  • Direct-acting oral anticoagulants (DOACs) are increasingly used for venous thromboembolism (VTE) treatment and prevention.
  • Pregnancy-induced physiological changes significantly alter drug pharmacokinetics and increase hypercoagulability postpartum.
  • Limited data exist on DOAC dosing and efficacy during the postpartum period (6-8 weeks after delivery).

Observation:

  • A 35-year-old postpartum woman presented with new-onset multiple segmental pulmonary embolism (PE) five days after initiating rivaroxaban for deep vein thrombosis (DVT).
  • No precipitating factors for thrombosis or treatment noncompliance were identified.
  • Rivaroxaban was discontinued, and the patient was treated with heparin, transitioned to enoxaparin, and then warfarin.

Findings:

  • This case represents the first reported instance of potential rivaroxaban failure in the postpartum period.
  • Postpartum pharmacokinetic alterations may lead to decreased rivaroxaban exposure and reduced anticoagulant efficacy.
  • The patient experienced recurrent PE despite appropriate rivaroxaban therapy initiation.

Implications:

  • Clinicians must carefully consider the risks and benefits of DOACs in postpartum patients due to potential efficacy alterations.
  • Further research is needed to understand the impact of postpartum pharmacokinetic changes on DOACs.
  • Development of monitoring assays for DOACs in special populations is warranted to ensure therapeutic efficacy and patient safety.