A Low Rivaroxaban Plasma Level May Indicate Anticoagulation Undertreatment
Simone Lorenzo Romano1, Paolo Chiarugi2, Monica Casini2
1Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, Pisa, Italy.
European Journal of Case Reports in Internal Medicine
|February 14, 2019
Summary
This case study highlights a patient with deep vein thrombosis who experienced treatment failure with rivaroxaban due to consistently low drug levels. Measuring rivaroxaban plasma concentrations may aid in managing anticoagulation therapy.
Area of Science:
- Pharmacology
- Hematology
- Clinical Medicine
Background:
- Limited data exists on the relationship between rivaroxaban plasma levels and clinical outcomes in venous thromboembolism (VTE) patients.
- Rivaroxaban is a direct oral anticoagulant used for VTE treatment and prevention.
Purpose of the Study:
- To report a case of deep vein thrombosis (DVT) occurring despite rivaroxaban therapy.
- To investigate the potential utility of monitoring plasma rivaroxaban concentrations in clinical practice.
Main Methods:
- Case report of a 44-year-old female patient with DVT.
- Analysis of plasma rivaroxaban levels and anti-Xa activity during treatment.
Main Results:
- The patient experienced recurrent DVT while on rivaroxaban.
- Repeatedly low plasma concentrations of rivaroxaban were observed.
- Postulated utility of measuring plasma rivaroxaban anti-Xa activity for therapy evaluation.
Conclusions:
- Some patients with DVT may not achieve therapeutic response to rivaroxaban.
- Accurate determination of rivaroxaban plasma concentrations is clinically significant.
- Inter- and intra-individual variability may affect the clinical utility of rivaroxaban plasma levels.
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