Rivaroxaban
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Intra-abdominal haemorrhage: case report An 84-year-old woman developed intra-abdominal haemorrhage while receiving anticoagulation therapy with rivaroxaban. The woman, who had a history of atrial fibrillation, had been receiving oral rivaroxaban 30mg daily. She was noted with a 5-mm adenoma in the hepatic flexure of the transverse colon. Due to her ongoing rivaroxaban treatment, endoscopic mucosal resection (EMR) was planned. Rivaroxaban was stopped on the day of the EMR. One day after the EMR, she was free of abdominal symptoms. Then, rivaroxaban was re-started, and she was discharged. Since the day after discharge, she reported experiencing gradual pain in the right hypochondrium. On day 4 after discharge, her abdominal pain worsened, and she had blood in the faeces. Subsequently, she presented to hospital. Clinical examinations revealed the following: temperature 36.6°C, BP 96/52mm Hg and HR of 68 bpm. Physical examination showed tenderness in the right hypochondrium without any signs of peritoneal irritation. Rectal examination was notable for small amount of blood-tainted faeces without active bleeding. CT-scan demonstrated ascites on the liver surface as well as in the pouch of Douglas. Haemoglobin level was found to be 6.8 g/dL suggesting severe anaemia. CRP levels were found to be mildly increased. CT was unable to find the source of bleeding. Pressure tenderness was found in the right hypochondrium. Based on the examinations, she was diagnosed with intra-abdominal haemorrhage. It was considered that the rivaroxaban therapy led to continuous bleeding by preventing haemostasis leading to the development of intra-abdominal haemorrhage [time to reaction onset not stated]. The woman was immediately hospitalised, and was administered two units of blood transfusion. Her rivaroxaban therapy was stopped due to the risk of thromboembolism. On the following day, haemoglobin improved to 8.1 g/dL, and the abdominal CT showed no free air or increase in ascites. Therefore, rivaroxaban treatment was continued from day 5 of hospitalisation. On day 30 after discharge, CT scan revealed complete disappearance of bloody ascites. Sato Y, et al. Intra-abdominal bleeding as a rare complication after colonic endoscopic mucosal resection in a patient taking direct oral anticoagulants. Clinical Journal of 803515991 Gastroenterology 13: 794-798, No. 5, Oct 2020. Available from: URL: http://doi.org/10.1007/s12328-020-01181-w
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Reactions 21 Nov 2020 No. 1831
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