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Various toxicities: 14 case reports In a retrospective cohort study of 197 patients who had undergone bioprosthetic valve replacement between January 2014 and June 2018, 14 patients [7 men and 7 women] aged 58–92 years were described, who developed gastrointestinal bleed, retroperitoneal bleed, septic shock, arteriovenous malformation, hypotension, haematuria, haemorrhagic stroke, lower gastrointestinal bleed, kidney haemorrhage, cerebrovascular accident or myocardial infraction during treatment with apixaban, rivaroxaban or warfarin for postoperative or preoperative atrial fibrillation. All the patients were admitted for bioprosthetic valve replacement. Due to postoperative or preoperative atrial fibrillation, the patients started receiving oral apixaban 2.5mg twice daily (2 patients), oral apixaban 5mg twice daily (6 patients), oral rivaroxaban 20mg daily (4 patients) and warfarin (2 patients) [not all routes and dosages stated]. After the bioprosthetic valve replacement, the patients were discharged. Following 2–162 days of the bioprosthetic valve replacement, the patients developed gastrointestinal bleed (3 patients), retroperitoneal bleed (1 patient), septic shock with arteriovenous malformation (1 patient), hypotension and gastrointestinal bleed (1 patient), haematuria (1 patient), lower gastrointestinal bleed due to arteriovenous malformation (1 patient), haemorrhagic stroke (1 patient), hypotension and kidney haemorrhage (1 patient), gastrointestinal bleed due to arteriovenous malformation (1 patient), cerebrovascular accident (2 patients) and myocardial infarction (1 patient). Consequently, the patients were re-admitted. The patients received packed red blood cells, fresh frozen plasma, prothrombin complex concentrate [Kcentra], vitamim K or lowdose of aspirin. Out of the 14 patients, 11 patients fully recovered [not all outcomes stated]. Pasciolla S, et al. Comparison of the Efficacy and Safety of Direct Oral Anticoagulants and Warfarin After Bioprosthetic Valve Replacements. Clinical Drug Investigation 40: 803519464 839-845, No. 9, 2020. Available from: URL: http://doi.org/10.1007/s40261-020-00939-x

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Reactions 5 Dec 2020 No. 1833