rivaroxaban and Hypoalbuminemia

Drugs exhibiting high protein binding have potential increased action in patients with hypoalbuminemia. Rivaroxaban is 92-95% protein bound, but the clinical effects of rivaroxaban in patients with low albumin are largely unknown. The purpose of this study was to evaluate the relationship between albumin and bleeding in rivaroxaban treated patients. This was a retrospective cohort study of hospitalized adults who received rivaroxaban and had an albumin level measured during admission between January and October 2017. Patients who experienced bleeding events while receiving rivaroxaban therapy where compared to those who did not. A multivariable logistic regression model was used to evaluate the association between albumin levels and bleeding events. A total of 368 patients were included; 30 experienced a bleeding event and 338 did not. The mean ± standard deviation albumin level nearest to the time of rivaroxaban initiation was significantly lower in patients who experienced a bleeding event (3.0 ± 0.75 g/dL vs 3.66 ± 0.54 g/dL, p < 0.0001). The multivariable logistic regression model yielded an almost 4.5 fold higher risk of bleeding (adjusted odds ratio 4.405; 95% confidence interval 2.21-9) with any 1 g/dL reduction in albumin. Admission hemoglobin was also associated with bleed risk in the model. Albumin levels were significantly associated with bleed risk in patients receiving rivaroxaban. Albumin levels should be considered when evaluating candidates for rivaroxaban therapy.

Topics: Atrial Fibrillation; Drug Monitoring; Factor Xa Inhibitors; Female; Hemorrhage; Humans; Hypoalbuminemia; Male; Middle Aged; Retrospective Studies; Risk Assessment; Risk Factors; Rivaroxaban; Serum Albumin; United States

Portal vein thrombosis (PVT) is a rare presentation in dogs with protein-losing enteropathy (PLE). Rivaroxaban, an oral, selective, direct factor Xa inhibitor, has not been reported to be administrated for canine PVT and the effect is unclear in dogs with PLE.. An 11-year-old Yorkshire Terrier presented with moderate ascites. The dog had severe hypoalbuminemia (1.2 g/dL), and a portal vein thrombus was confirmed on computed tomographic angiography (CTA). On endoscopic examination, it became apparent that the hypoalbuminemia was caused by PLE, which was consequent of lymphatic dilation and lymphoplasmacytic enteritis. Therefore, the dog was initially treated with oral administrations of spironolactone and clopidogrel, with dietary fat restriction. However, a follow-up CTA showed no changes in the ascites, thrombus, and portal vein to aorta (PV/Ao) ratio. Therefore, the dog was additionally prescribed rivaroxaban and low-dose prednisolone for the portal vein thrombus and hypoalbuminemia due to lymphoplasmacytic enteritis, respectively. Following the treatment, the PV/Ao ratio decreased because of a decrease in the thrombus and the ascites disappeared completely with an elevation of albumin concentration (1.9 g/dL).. This case report demonstrated that oral administration of rivaroxaban combined with low-dose glucocorticoid was effective management for PVT in a dog with PLE.

Topics: Administration, Oral; Animals; Computed Tomography Angiography; Dog Diseases; Dogs; Factor Xa Inhibitors; Female; Glucocorticoids; Hypoalbuminemia; Portal Vein; Prednisolone; Protein-Losing Enteropathies; Rivaroxaban; Venous Thrombosis