Reactions 1704, p327 - 2 Jun 2018 Prothrombin complex concentrate/ rivaroxaban Various toxicities: case report A 70-year-old man died due to ST segment elevation myocardial infarction, cardiac arrest and cardiac shock during treatment with prothrombin complex concentrate followed by bleeding during treatment with rivaroxaban [routes not stated, not all dosages stated]. The man, who had cholangiocarcinoma, jaundice, hypothyroidism, chronic kidney disease, liver failure, confusion and lower extremities deep vein thrombosis, presented to the emergency department for worsening generalised weakness. He received treatment with rivaroxaban for lower extremities deep vein thrombosis. His concomitant medications included furosemide and spironolactone. He underwent various physical and blood examinations, which revealed anaemia, pitting oedema and thrombocytopenia. His international normalized ratio (INR) was found to be prolonged. Total bilirubin level was found to be 6.3 mg/dL while AST and ALT levels were elevated. ECG showed right bundle branch block. He was admitted to the ICU for a presumed diagnosis of sepsis. He received treatment with unspecified antibiotics, resuscitated with fluids, maintained on low dose norepinephrine. However, pancultures results ruled out bacterial peritonitis. The man’s rivaroxaban treatment was withheld. After a few hours, he developed epistaxis. Emergent peripheral blood smear showed only low platelets count and macrocytic anaemia without any schistocytes ruling out disseminated intravascular coagulation. The patient’s coagulopathic state was attributed to both the use of rivaroxaban and worsening liver failure with prolonged INR secondary to the progression of his cholangiocarcinoma. He received treatment with prothrombin complex concentrate 35 U/kg at a rate of 0.12 mL/kg/minute for reverse coagulopathy [off-label use]. By the end of the prothrombin complex concentrate infusion, an ECG revealed evolving antero-septo lateral ST segment elevation myocardial infarction. Troponin level had markedly increased. It was further complicated to cardiac arrest. The efforts to resuscitate him went in vain and he died. Author comment: "Our article describes the first case of STEMI that occurred in a [prothrombin complex concentrate]- naive patient with no genetic bleeding disorder". "His stay was complicated by uncontrolled bleeding secondary to rivaroxaban use and advanced liver disease. By the end of the prothrombin complex concentrate infusion used to reverse his coagulopathy, patient developed ST-segment elevation myocardial infarction with cardiogenic shock and passed away." Tabet R, et al. Prothrombin complex concentrate and fatal thrombotic adverse events: A complication to keep in mind. Drug Discoveries and Therapeutics 12: 104-107, No. 2, 2018. Available from: URL: https://doi.org/10.5582/ ddt.2018.01012 - USA 803323284 0114-9954/18/1704-0001/$14.95 Adis © 2018 Springer International Publishing AG. All rights reserved Reactions 2 Jun 2018 No. 1704
Reactions Weekly – Springer Journals
Published: Jun 2, 2018
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