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Medication Error When Switching from Warfarin to Rivaroxaban Leading to Spontaneous Large Ecchymosis of the Abdominal and Chest Wall

Non-vitamin K oral anticoagulant (NOAC) therapy may be inappropriate if prescription was incorrect, the patient’s physiological parameters change, or interacting concomitant medications are erroneously added. The aim of this report was to illustrate inappropriate NOAC prescription in a 78-year-old w...

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Autores principales: Egger, Flavio, Targa, Federica, Unterholzner, Ivan, Grant, Russell P., Herrmann, Markus, Wiedermann, Christian J.
Formato: Online Artículo Texto
Lenguaje:English
Publicado: PAGEPress Publications, Pavia, Italy 2016
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5067405/
https://www.ncbi.nlm.nih.gov/pubmed/27777713
http://dx.doi.org/10.4081/cp.2016.873
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author Egger, Flavio
Targa, Federica
Unterholzner, Ivan
Grant, Russell P.
Herrmann, Markus
Wiedermann, Christian J.
author_facet Egger, Flavio
Targa, Federica
Unterholzner, Ivan
Grant, Russell P.
Herrmann, Markus
Wiedermann, Christian J.
author_sort Egger, Flavio
collection PubMed
description Non-vitamin K oral anticoagulant (NOAC) therapy may be inappropriate if prescription was incorrect, the patient’s physiological parameters change, or interacting concomitant medications are erroneously added. The aim of this report was to illustrate inappropriate NOAC prescription in a 78-year-old woman with non-valvular atrial fibrillation and borderline renal dysfunction who was switched from warfarin to rivaroxaban and subsequently developed bruising with hemorrhagic shock and acute on chronic renal failure. Administration of 4-factor prothrombin complex concentrate effectively reversed coagulopathy and stopped bleeding. Retrospective determination of circulating plasma levels of rivaroxaban and warfarin confirmed that excessive anticoagulation was likely due to warfarin that the patient probably continued to take although rivaroxaban was initiated. Pharmacodynamic interaction between rivaroxaban and warfarin may not only be additive but synergistic. In patients at high risk of complications, judicious prescribing and dosing of NOACs, and regular monitoring of concomitant medications and renal function are highly recommended.
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spelling pubmed-50674052016-10-24 Medication Error When Switching from Warfarin to Rivaroxaban Leading to Spontaneous Large Ecchymosis of the Abdominal and Chest Wall Egger, Flavio Targa, Federica Unterholzner, Ivan Grant, Russell P. Herrmann, Markus Wiedermann, Christian J. Clin Pract Case Report Non-vitamin K oral anticoagulant (NOAC) therapy may be inappropriate if prescription was incorrect, the patient’s physiological parameters change, or interacting concomitant medications are erroneously added. The aim of this report was to illustrate inappropriate NOAC prescription in a 78-year-old woman with non-valvular atrial fibrillation and borderline renal dysfunction who was switched from warfarin to rivaroxaban and subsequently developed bruising with hemorrhagic shock and acute on chronic renal failure. Administration of 4-factor prothrombin complex concentrate effectively reversed coagulopathy and stopped bleeding. Retrospective determination of circulating plasma levels of rivaroxaban and warfarin confirmed that excessive anticoagulation was likely due to warfarin that the patient probably continued to take although rivaroxaban was initiated. Pharmacodynamic interaction between rivaroxaban and warfarin may not only be additive but synergistic. In patients at high risk of complications, judicious prescribing and dosing of NOACs, and regular monitoring of concomitant medications and renal function are highly recommended. PAGEPress Publications, Pavia, Italy 2016-08-11 /pmc/articles/PMC5067405/ /pubmed/27777713 http://dx.doi.org/10.4081/cp.2016.873 Text en ©Copyright F. Egger et al. http://creativecommons.org/licenses/by-nc/3.0/ This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.
spellingShingle Case Report
Egger, Flavio
Targa, Federica
Unterholzner, Ivan
Grant, Russell P.
Herrmann, Markus
Wiedermann, Christian J.
Medication Error When Switching from Warfarin to Rivaroxaban Leading to Spontaneous Large Ecchymosis of the Abdominal and Chest Wall
title Medication Error When Switching from Warfarin to Rivaroxaban Leading to Spontaneous Large Ecchymosis of the Abdominal and Chest Wall
title_full Medication Error When Switching from Warfarin to Rivaroxaban Leading to Spontaneous Large Ecchymosis of the Abdominal and Chest Wall
title_fullStr Medication Error When Switching from Warfarin to Rivaroxaban Leading to Spontaneous Large Ecchymosis of the Abdominal and Chest Wall
title_full_unstemmed Medication Error When Switching from Warfarin to Rivaroxaban Leading to Spontaneous Large Ecchymosis of the Abdominal and Chest Wall
title_short Medication Error When Switching from Warfarin to Rivaroxaban Leading to Spontaneous Large Ecchymosis of the Abdominal and Chest Wall
title_sort medication error when switching from warfarin to rivaroxaban leading to spontaneous large ecchymosis of the abdominal and chest wall
topic Case Report
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5067405/
https://www.ncbi.nlm.nih.gov/pubmed/27777713
http://dx.doi.org/10.4081/cp.2016.873
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