rivaroxaban and Necrosis

Pegaspargase has been used in the treatment of acute lymphoblastic leukemia with promising results. However, it has also been associated with several potentially serious complications, including thrombosis. Pegaspargase-induced cerebral venous thrombosis and bone marrow necrosis are very rare.. A 50-year-old female developed headache, weakness of the right lower extremity, fever, and bone pain after chemotherapy including pegaspargase for the treatment of acute lymphoblastic leukemia.. Her imaging studies and bone marrow examinations were compatible with cerebral venous thrombosis and bone marrow necrosis.. The patient received anticoagulation therapy with rivaroxaban.. After treatment with rivaroxaban, she had a good outcome without major or minor bleeding.. Clinicians should be aware of the very rare but possible induction of bone marrow necrosis during pegaspargase treatment when there is necrosis in other organs. Because of its greater safety and convenience, rivaroxaban gains popularity over traditional anticoagulant drugs.

Topics: Antineoplastic Agents; Asparaginase; Bone Marrow; Female; Humans; Middle Aged; Necrosis; Polyethylene Glycols; Remission Induction; Rivaroxaban; Sinus Thrombosis, Intracranial

Topics: Adult; Erythema; Factor Xa Inhibitors; Foot Dermatoses; Humans; Male; Necrosis; Rivaroxaban

Topics: Adolescent; Female; Humans; Necrosis; Protein C; Protein C Deficiency; Rivaroxaban; Secondary Prevention; Skin Diseases; Thrombin; Thrombomodulin; Warfarin

Topics: Aged; Anticoagulants; Drug Substitution; Factor Xa Inhibitors; Humans; Kidney Diseases; Male; Necrosis; Rivaroxaban; Skin; Skin Diseases; Warfarin; Wound Healing

Topics: Adult; Anticoagulants; Female; Humans; Necrosis; Rivaroxaban; Skin Diseases; Treatment Outcome; Venous Thromboembolism

The aim of this study was to evaluate the effects of the antithrombotic agents enoxaparin and rivaroxaban on tissue survival following skin degloving injury in an experimental rat tail model.. The study included 24 rats divided into three equal groups of 8; the enoxaparin group (Group 1), the rivaroxaban group (Group 2) and the saline control group (Group 3). A degloving injury was created by making a circular incision 5 cm distal to the base of the tail; manual traction was applied to the tail skin distal to the incision. After 15 minutes, the ends of the incision were sutured back in place. Antithrombotic agents were administered immediately after suturing and repeated once a day for 15 days. At the end of Day 15, the experiment was terminated. Gross morphological tissue survival and histopathology were evaluated.. Histopathological examination of the enoxaparin and rivaroxaban groups revealed that the skin was mostly normal or intact with minimal inflammation. The mean length of necrotic area was significantly higher in the saline group compared to the enoxaparin and rivaroxaban groups (p<0.05). No statistically significant differences were noted between the rivaroxaban and enoxaparin groups (p=0.451). The mean extent of skin necrosis was significantly higher in the control group than the study groups (p<0.05), while there was no significant difference in the length of necrotic area between Group 1 and 2 (p=0.722).. Rivaroxaban and enoxaparin improved tissue survival in skin degloving injuries in terms of gross morphological and histopathological findings in a rat tail model.

Topics: Animals; Disease Models, Animal; Enoxaparin; Fibrinolytic Agents; Inflammation; Male; Morpholines; Necrosis; Rats; Rats, Sprague-Dawley; Rivaroxaban; Skin; Soft Tissue Injuries; Thiophenes; Tissue Survival; Trauma Severity Indices; Treatment Outcome

Treatment with the new oral anticoagulant rivaroxaban can be associated with severe liver injury.. We report 2 patients with predominantly hepatocellular liver injury that had onset during treatment with rivaroxaban. Both were symptomatic, had massively elevated transaminase activity levels and hyperbilirubinemia, and fulfilled the criteria of Hy's law. Liver biopsy in 1 patient revealed centroacinar hepatocyte necrosis as the predominant finding. Both patients showed a rapid biochemical and clinical recovery after discontinuing rivaroxaban therapy. Between 2008 and 2013, 42 cases of liver injury possibly associated with rivaroxaban treatment have been reported to the Swiss Agency of Therapeutic Products (Swissmedic). Thirteen of these patients fulfilled the criteria of Hy's law.. Treatment with rivaroxaban can be associated with severe, symptomatic liver injury. Physicians should be aware of this adverse drug reaction. We propose rapid discontinuation of treatment with rivaroxaban in case of symptomatic liver injury and, taking into account its severity, avoiding reexposure.

Topics: Aged; Arthroplasty, Replacement, Knee; Factor Xa Inhibitors; Female; Fracture Fixation, Internal; Hepatocytes; Humans; Hyperbilirubinemia; Liver; Male; Middle Aged; Morpholines; Necrosis; Primary Prevention; Rivaroxaban; Thiophenes; Tibial Fractures; Venous Thrombosis