rivaroxaban and Adrenal-Gland-Diseases

A 46-year-old man with antiphospholipid syndrome (APS) and previous pulmonary embolism on anticoagulation with rivaroxaban was brought in to the hospital after a syncopal episode. He was found to be hypotensive and tachycardic and later admitted to the intensive care unit. Clinical presentation and laboratory findings were consistent with adrenal insufficiency. MRI revealed bilateral adrenal haemorrhage and he received appropriate steroid replacement therapy. Symptoms slowly subsided and anticoagulation regimen was changed to warfarin. Adrenal haemorrhage was likely caused by APS and rivaroxaban, which brings into question whether novel oral anticoagulants are safe in this patient population.

Topics: Adrenal Gland Diseases; Adrenal Insufficiency; Anticoagulants; Antiphospholipid Syndrome; Hemorrhage; Heparin; Humans; Male; Middle Aged; Pulmonary Embolism; Rivaroxaban; Treatment Outcome; Warfarin

This is the report of a case of a 63-year-old woman, with a history of recurrent deep vein thrombosis, who was admitted with abdominal pain and diagnosed with bilateral adrenal hemorrhage, resulting in acute adrenal insufficiency. Several risk factors for adrenal hemorrhage were present: stress because of infection, treatment with the factor Xa-inhibitor rivaroxaban and the presence of antiphospholipid antibodies. Venous thrombosis of the adrenal glands with subsequent hemorrhagic infarction is a possible mechanism. It is currently unclear if patients with antiphospholipid syndrome can be treated effectively and safely with a nonvitamin K-antagonist oral anticoagulant.

Topics: Adrenal Gland Diseases; Factor Xa Inhibitors; Female; Hemorrhage; Humans; Middle Aged; Rivaroxaban