scholarly journals Dabigatran-Induced Spontaneous Hemopericardium and Cardiac Tamponade

2017 ◽  
Vol 44 (5) ◽  
pp. 370-372 ◽  
Author(s):  
Qurat-ul-ain Jelani ◽  
Ram Gordon ◽  
Adam Schussheim
Keyword(s):  
Atrial Fibrillation ◽  
Bleeding Complication ◽  
Unusual Case ◽  
Thromboembolic Events ◽  
Nonvalvular Atrial Fibrillation ◽  
Reversal Agent ◽  
Risk Of Bleeding ◽  
Patient Status ◽  
Novel Oral Anticoagulant ◽  
Newer Anticoagulants

Four novel oral anticoagulant agents are currently available for the prevention and treatment of thromboembolic events in patients with nonvalvular atrial fibrillation. We present an unusual case of spontaneous hemopericardium and tamponade in an 87-year-old man with atrial fibrillation who was taking one such agent, dabigatran, as thromboprophylaxis. Our case highlights both a rare bleeding complication of dabigatran use and the effectiveness of idarucizumab, its newly approved reversal agent. Especially in elderly patients, we recommend that clinicians evaluate risk factors, closely monitor patient status, and consider alternatives to the newer anticoagulants when the risk of bleeding is high.

scholarly journals First Reported Case of Hemopericardium Related to Dabigatran Use Reversed by New Antidote Idarucizumab

2017 ◽  
Vol 2017 ◽  
pp. 1-3 ◽  
Author(s):  
Steven Song ◽  
Joselle Cook ◽  
Clive Goulbourne ◽  
Matthew Meade ◽  
Louis Salciccioli ◽  
...  
Keyword(s):  
Paradigm Shift ◽  
Multiorgan Failure ◽  
Nonvalvular Atrial Fibrillation ◽  
Reversal Agent ◽  
Reversal Agents ◽  
Risk Of Bleeding ◽  
Increased Risk ◽  
Novel Oral Anticoagulant ◽  
Hemorrhagic Events ◽  
Life Threatening

Dabigatran, the first novel oral anticoagulant (NOAC) with a reversal agent, heralded a paradigm shift in the treatment of nonvalvular atrial fibrillation. The potential for life-threatening hemorrhagic events with the use of NOACs has been highly debated since the effectiveness of reversal agents such as idarucizumab is based primarily on pharmacologic data. It is known that cancer patients are at an increased risk of bleeding with anticoagulation, though specific studies demonstrating the risks or efficacy of NOACs in this population are lacking. We provide the first report of hemopericardium resulting in multiorgan failure related to dabigatran use that was successfully reversed by idarucizumab in a man with prostate cancer on chemotherapy.

Probable Rivaroxaban-Induced Full Body Rash: A Case Report

2017 ◽  
Vol 31 (5) ◽  
pp. 503-506 ◽  
Author(s):  
Evan Sasson ◽  
Marian James ◽  
Mark Russell ◽  
Darko Todorov ◽  
Henry Cohen
Keyword(s):  
Atrial Fibrillation ◽  
Adverse Drug Events ◽  
Factor Xa ◽  
Similar Reaction ◽  
Medication Regimen ◽  
Nonvalvular Atrial Fibrillation ◽  
Novel Oral Anticoagulant ◽  
History Of ◽  
Potential Issue ◽  
Full Body

Introduction: Rivaroxaban is a novel oral anticoagulant with several indications, one of which is for stroke prevention in nonvalvular atrial fibrillation. We present a case of probable rivaroxaban-induced rash. Case Summary: A 79-year-old female with a medical history of atrial fibrillation experienced a stroke, after which she was prescribed rivaroxaban 20 mg. After several days, she developed a rash requiring admission to the emergency department and several days of treatment. The rash resolved and she was switched from rivaroxaban to apixaban and did not experience any adverse drug events. Discussion: Onset of symptoms occurred within days of rivaroxaban initiation. The patient had no allergy history and never reported a similar reaction while on concurrent home medication regimen. The resolution of rash and toleration of apixaban suggest a rivaroxaban-specific reaction. The mechanism of this rash is currently unclear. Conclusion: We report one of the first cases of probable rivaroxaban-induced rash, whereas the patient tolerated apixaban. Further investigation is warranted, but prescribers should be cognizant of this potential issue when choosing a factor Xa inhibitor for anticoagulation.

scholarly journals Optimal choice of prophylactic anticoagulant therapy for nonvalvular atrial fibrillation in the context of COVID-19 pandemic

2021 ◽  
Vol 26 (8) ◽  
pp. 4607
Author(s):  
A. S. Polyakov ◽  
V. V. Tyrenko ◽  
E. V. Kryukov ◽  
Ya. A. Noskov
Keyword(s):  
Atrial Fibrillation ◽  
Cardiovascular Disease ◽  
Anticoagulant Therapy ◽  
Organ Damage ◽  
Optimal Choice ◽  
Common Type ◽  
Thromboembolic Events ◽  
Nonvalvular Atrial Fibrillation ◽  
Initial Infection ◽  
Supraventricular Tachyarrhythmia

Already at the very beginning of COVID-19 pandemic, it became known about the key clinical and pathogenetic significance of immunopathological reactions and disorders of hemostasis. Specific coagulopathy, microvascular thromboinflammatory organ damage, macrothrombosis and thromboembolism in the acute period of COVID-19, as well as secondary hemostasis disorders in convalescents, actualize the issues of caring patients with cardiovascular disease. COVID-19 not only increases the risk of thromboembolic events for patients with previously identified arrhythmias, but can also indirectly cause it (as a complication of infection or therapy). The aim of this work was to summarize the data and substantiate the optimal choice of prophylactic anticoagulant therapy for nonvalvular atrial fibrillation during the COVID-19 pandemic. Atrial fibrillation is not only the most common type of supraventricular tachyarrhythmia, but it is also the main underlying cause of more than half of cardioembolic stroke cases, which requires effective thromboprophylaxis. While maintaining the infectious danger for patients, the anticoagulant selection should take into account the possible dysfunctions and drug interactions during the initial infection or reinfection of COVID-19, as well as the possibility of rapid anticoagulant action reverse if surgery is required or bleeding develops. The optimal choice seems to be the use of dabigatran, which is characterized by the best safety profile for hepato- and nephrotoxicity, cytochrome P450-independent metabolism, and the presence of an antidote.

Abstract 159: Evaluation of Clinical Outcomes among Nonvalvular Atrial Fibrillation Patients Treated With Warfarin or Rivaroxaban Stratified by Presence or Absence of CKD in a Claims Database

2017 ◽  
Vol 10 (suppl_3) ◽  
Author(s):  
Matthew R Weir ◽  
Lloyd Haskell ◽  
Jeffrey S Berger ◽  
Veronica Ashton ◽  
François Laliberté ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Ischemic Stroke ◽  
Major Bleeding ◽  
Bleeding Event ◽  
Data Availability ◽  
Thromboembolic Events ◽  
Bleeding Events ◽  
Nonvalvular Atrial Fibrillation ◽  
Claims Database ◽  
Increased Risk

Introduction: Renal functional impairment is linked to an increased risk of thromboembolic and bleeding events in patients with nonvalvular atrial fibrillation (NVAF) treated with warfarin and rivaroxaban. Anticoagulants such as warfarin and rivaroxaban are often recommended to reduce the risk of stroke in NVAF patients. The purpose of this study was to evaluate and compare thromboembolic and bleeding event rates for warfarin and rivaroxaban patients stratified by presence of chronic kidney disease (CKD). Methods: Claims from the IMS Health Real-World Data Adjudicated Claims database from 05/2011-6/2015 were analyzed. Adult patients with NVAF who had ≥6 months of baseline data prior to the first dispensing of warfarin or rivaroxaban after 11/2011 were included. Patients were followed until the end of index therapy or end of data availability/insurance coverage. Outcomes were stratified by presence of CKD for ischemic stroke, major bleeding, and a composite measure of thromboembolic events (ischemic stroke, myocardial infarction (MI) or venous thromboembolism (VTE)) and analyzed using hazard ratios (HRs). Adjustments for confounding were made with inverse probability of treatment weights (IPTW). Results: The analysis included 39,872 rivaroxaban (9.0% [3,572 of 39,872] with CKD) and 48,637 warfarin patients (16.9% [8,230 of 48,637] with CKD). As expected, thromboembolic and bleeding events were more common in patients with CKD than those without CKD. Rivaroxaban patients had significantly lower risk of ischemic stroke, both in the overall population (HR = 0.79 [0.68-0.90], p=0.0008) and for those with CKD (HR = 0.55 [0.40-0.77], p=0.0004). A composite of thromboembolic events were lower with rivaroxaban irrespective of CKD. Major bleeding rates were comparable across all groups. Table 1 reports incidence rates and HRs stratified by presence of CKD. Conclusions: This study suggests that, in an adult population with NVAF, rivaroxaban-treated patients had fewer ischemic strokes across all patients, including patients with renal impairment. Rivaroxaban-treated patients also had significantly better outcomes for the composite (VTE, MI, or stroke) measure across all groups. Bleeding rates were comparable across all groups.

scholarly journals Accumulation of Risk Factors Increases Risk of Thromboembolic Events in Patients With Nonvalvular Atrial Fibrillation

2006 ◽  
Vol 70 (6) ◽  
pp. 651-656 ◽  
Author(s):  
Hiroshi Inoue ◽  
Takashi Nozawa ◽  
Tadakazu Hirai ◽  
Atsushi Iwasa ◽  
Ken Okumura ◽  
...  
Keyword(s):  
Risk Factors ◽  
Atrial Fibrillation ◽  
Thromboembolic Events ◽  
Nonvalvular Atrial Fibrillation
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