rivaroxaban and Drug-Hypersensitivity

Non-vitamin K antagonist oral anticoagulants (NOACs) are increasingly being used in hospital and outpatient settings as safe alternatives to warfarin. Hypersensitivity reactions have been described for NOACs and can be classified according to Gell and Coombs. We reviewed case reports of possible drug hypersensitivity reactions, noticing a predominance of delayed reactions (both mild and severe) and the absence of cross-reactions to warfarin and low molecu-lar weight heparins. International experience on diagnostic tests is lacking. The vast majority of authors refer to probability scores and rely on biopsy to classify vasculitis and rule out differential diagnoses. We propose to adapt available tests to confirm the patient's reactivity to new anticoagulants. Among in vivo tests, patch testing revealed promising in delayed reactions.

Topics: Anticoagulants; Dabigatran; Drug Hypersensitivity; Humans; Pyrazoles; Pyridines; Pyridones; Rivaroxaban; Thiazoles

Vitamin K antagonists, such as warfarin, are considered to be the treatment of choice to prevent thromboembolic events, but problems, such as the need for frequent dose adjustment and monitoring of coagulation status, as well as multiple drug and food interactions, make their use difficult for both physician and patient. Two new anticoagulants are now being considered as possible replacements of vitamin K antagonists. Dabigatran, an oral direct thrombin inhibitor has already been approved in the USA for prevention of stroke in patients with atrial fibrillation. Rivaroxaban, a factor Xa inhibitor, and dabigatran are licensed in Europe and Canada for short-term thromboprophylaxis after elective hip or knee replacement surgery. The advantages of these drugs are that they are safe and effective, require no monitoring, have a direct mode of action against only one clotting factor (thrombin or factor Xa), have limited drug interactions, and have rapid peak blood levels. Based on the fact that dabigatran has already been approved for use in the USA, it would appear that it has an advantage over rivaroxaban in becoming the replacement drug for vitamin K antagonists.

Topics: Administration, Oral; Anticoagulants; Benzimidazoles; beta-Alanine; Dabigatran; Drug Hypersensitivity; Drug Interactions; Factor Xa Inhibitors; Gastritis; Hemorrhage; Humans; Liver; Morpholines; Rivaroxaban; Thiophenes; Thromboembolism

Anticoagulant therapy is indicated for the prevention and treatment of thromboembolic disease. Direct oral anticoagulants (DOACs) are frequently prescribed and Rivaroxaban is the most frequently administered DOAC in the Netherlands. Most side effects relate to hemorrhagic complications, however, also non-hemorrhagic side effect may be potentially life threatening.. A 74-year-old man presented at the emergency department with a ruptured infrarenal abdominal aortic aneurysm for which open aneurysm repair was performed. Postoperatively, the patient developed neurological deficit, respiratory and circulatory failure following rivaroxaban administration, initiated for atrial fibrillation. Even though, the clinical signs resembled an anaphylactic reaction, the skin-prick test was negative and complications most likely resulted from a non-allergic drug hypersensitivity reaction.. This case report shows that non-allergic drug hypersensitivity reactions may mimic an anaphylactic reaction and can be potentially life threatening. In addition, severe non-hemorrhagic complications after rivaroxaban administration do occur and should be considered in case of acute clinical deterioration.

Topics: Aged; Anaphylaxis; Drug Hypersensitivity; Factor Xa Inhibitors; Humans; Male; Netherlands; Predictive Value of Tests; Rivaroxaban; Treatment Outcome

A case of a patient who developed a hypersensitivity reaction to rivaroxaban in the form of a diffuse, exanthematous rash is reported.. After starting rivaroxaban for treatment of cancer-associated deep vein thrombosis (DVT) with pulmonary embolism (PE), a 69-year-old Caucasian woman arrived at an oncology clinic with a diffuse, exanthematous (morbilliform) rash on her neck and torso, spreading to her upper and lower extremities. She reported that the symptoms started to develop about 48 hours after transitioning from subcutaneous enoxaparin to oral rivaroxaban. The patient's symptoms did not subside with diphenhydramine 25-50 mg orally every 6-8 hours. The patient was switched back to enoxaparin therapy for continued anticoagulation therapy. On day 5, rivaroxaban and diphenhydramine were discontinued. Oral dexamethasone 4 mg twice daily was initiated, and the patient transitioned from rivaroxaban to enoxaparin 1 mg/kg every 12 hours subcutaneously. On day 8, the rash had diminished considerably and was present only on her thighs. Analysis of the case using the adverse drug reaction probability scale of Naranjo et al. indicated that rivaroxaban was the probable cause of the hypersensitivity reaction. Four prior case reports of rivaroxaban hypersensitivity manifesting as a rash have been previously reported, with this being the first in a female and the first in a patient undergoing treatment of DVT and PE in the setting of active cancer.. A 69-year-old Caucasian woman developed a diffuse, exanthematous rash on day 3 of rivaroxaban treatment. Symptoms abated after rivaroxaban discontinuation and treatment with dexamethasone.

Topics: Aged; Drug Hypersensitivity; Exanthema; Factor Xa Inhibitors; Female; Humans; Rivaroxaban; Treatment Outcome

Rivaroxaban is an oral anticoagulant, currently licensed for use as a venous thromboembolism (VTE) prophylaxis, and recommended by the National Institute for Clinical Excellence (NICE) for all patients undergoing elective hip and knee replacement surgery in the UK. We present the first case of a suspected hypersensitivity to rivaroxaban.. A 57-year-old man with no previous allergies underwent an uncomplicated, elective partial knee replacement, after which he was prescribed a routine 2-week course of rivaroxaban 10 mg. He developed an allergic response requiring readmission for assessment and treatment 7 days post-operatively.. We believe this to be the first published case of hypersensitivity associated with rivaroxaban. More research is needed to determine this association. At the same time, given the growing range and increasing use of anticoagulants, particular vigilance is required regarding potential side effects so that these may be managed quickly and effectively in the early stages.

Topics: Anticoagulants; Arthroplasty, Replacement, Knee; Drug Hypersensitivity; Humans; Male; Middle Aged; Morpholines; Rivaroxaban; Thiophenes