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Rivaroxaban and Piperacillin-Tazobactam: Case of Massive Gastrointestinal Bleeding
Abbas Mohammadi1, Masoud Bitarafan1, Korosh Hamed Saedian1
1Department of Internal Medicine, Valley Health System, Las Vegas, Nevada, USA.
Case Reports in Medicine
|February 2, 2026
Summary
This case report details a patient on rivaroxaban who experienced severe gastrointestinal bleeding after starting piperacillin-tazobactam (PTZ). Discontinuing both medications successfully managed the bleeding, highlighting potential drug interactions.
Area of Science:
- Pharmacology
- Internal Medicine
- Gastroenterology
Background:
- Anticoagulated patients face heightened risks of drug interactions, particularly with antibiotics.
- Piperacillin-tazobactam (PTZ) is known to affect coagulation, posing a potential bleeding risk when combined with anticoagulants.
Purpose of the Study:
- To report the first documented case of massive gastrointestinal bleeding potentially linked to piperacillin-tazobactam (PTZ) in a patient receiving rivaroxaban.
- To emphasize the importance of monitoring and managing potential drug interactions between antibiotics and anticoagulants.
Main Methods:
- Case report of a 52-year-old male patient with deep vein thrombosis on rivaroxaban.
- Administration of piperacillin-tazobactam (PTZ) for severe leg cellulitis.
- Clinical monitoring, cessation of both medications, and esophagogastroduodenoscopy (EGD) for bleeding management.
Main Results:
- The patient developed massive gastrointestinal bleeding (hematochezia, hematemesis, syncope) shortly after initiating PTZ.
- Esophagogastroduodenoscopy revealed minor erosions.
- Discontinuation of both rivaroxaban and PTZ led to successful management of the bleeding episode.
Conclusions:
- A potential interaction between piperacillin-tazobactam (PTZ) and rivaroxaban may disrupt hemostasis, leading to severe gastrointestinal bleeding.
- Vigilant monitoring for drug interactions and prompt management are crucial for anticoagulated patients.
- Further research is warranted to investigate the interaction between PTZ and anticoagulants.
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