A Rare Case of Spontaneous Cardiac Tamponade Induced by Concomitant Use of Rivaroxaban and Amiodarone
Rivaroxaban is a direct oral anticoagulant (DOAC) approved as an important alternative to warfarin in patients with nonvalvular atrial fibrillation. We report the case of an 87-year-old man with past medical history of nonvalvular atrial fibrillation on rivaroxaban and recently started amiodarone fo...
Autores principales: | , , , |
---|---|
Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
Hindawi
2018
|
Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6109521/ https://www.ncbi.nlm.nih.gov/pubmed/30159173 http://dx.doi.org/10.1155/2018/1650716 |
_version_ | 1783350339369435136 |
---|---|
author | Oladiran, Oreoluwa Segal, Jared Nwosu, Ifeanyi Nazir, Salik |
author_facet | Oladiran, Oreoluwa Segal, Jared Nwosu, Ifeanyi Nazir, Salik |
author_sort | Oladiran, Oreoluwa |
collection | PubMed |
description | Rivaroxaban is a direct oral anticoagulant (DOAC) approved as an important alternative to warfarin in patients with nonvalvular atrial fibrillation. We report the case of an 87-year-old man with past medical history of nonvalvular atrial fibrillation on rivaroxaban and recently started amiodarone for pulseless ventricular tachycardia who presented to our hospital with intermittent chest pain and was diagnosed with spontaneous hemopericardium causing cardiac tamponade. The culprit drugs were discontinued, and the patient was treated with emergent pericardiocentesis. Both rivaroxaban and amiodarone are substrates for the CYP3A4 hepatic pathway, and concomitant use can result in increased plasma rivaroxaban levels causing an increased propensity to bleeding. While most physicians are cognizant of the need for renal dosing of rivaroxaban, this article aims to increase awareness of its interactions with drugs that are also metabolized through the same hepatic CYP450 pathway. |
format | Online Article Text |
id | pubmed-6109521 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2018 |
publisher | Hindawi |
record_format | MEDLINE/PubMed |
spelling | pubmed-61095212018-08-29 A Rare Case of Spontaneous Cardiac Tamponade Induced by Concomitant Use of Rivaroxaban and Amiodarone Oladiran, Oreoluwa Segal, Jared Nwosu, Ifeanyi Nazir, Salik Case Rep Cardiol Case Report Rivaroxaban is a direct oral anticoagulant (DOAC) approved as an important alternative to warfarin in patients with nonvalvular atrial fibrillation. We report the case of an 87-year-old man with past medical history of nonvalvular atrial fibrillation on rivaroxaban and recently started amiodarone for pulseless ventricular tachycardia who presented to our hospital with intermittent chest pain and was diagnosed with spontaneous hemopericardium causing cardiac tamponade. The culprit drugs were discontinued, and the patient was treated with emergent pericardiocentesis. Both rivaroxaban and amiodarone are substrates for the CYP3A4 hepatic pathway, and concomitant use can result in increased plasma rivaroxaban levels causing an increased propensity to bleeding. While most physicians are cognizant of the need for renal dosing of rivaroxaban, this article aims to increase awareness of its interactions with drugs that are also metabolized through the same hepatic CYP450 pathway. Hindawi 2018-08-12 /pmc/articles/PMC6109521/ /pubmed/30159173 http://dx.doi.org/10.1155/2018/1650716 Text en Copyright © 2018 Oreoluwa Oladiran et al. http://creativecommons.org/licenses/by/4.0/ This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. |
spellingShingle | Case Report Oladiran, Oreoluwa Segal, Jared Nwosu, Ifeanyi Nazir, Salik A Rare Case of Spontaneous Cardiac Tamponade Induced by Concomitant Use of Rivaroxaban and Amiodarone |
title | A Rare Case of Spontaneous Cardiac Tamponade Induced by Concomitant Use of Rivaroxaban and Amiodarone |
title_full | A Rare Case of Spontaneous Cardiac Tamponade Induced by Concomitant Use of Rivaroxaban and Amiodarone |
title_fullStr | A Rare Case of Spontaneous Cardiac Tamponade Induced by Concomitant Use of Rivaroxaban and Amiodarone |
title_full_unstemmed | A Rare Case of Spontaneous Cardiac Tamponade Induced by Concomitant Use of Rivaroxaban and Amiodarone |
title_short | A Rare Case of Spontaneous Cardiac Tamponade Induced by Concomitant Use of Rivaroxaban and Amiodarone |
title_sort | rare case of spontaneous cardiac tamponade induced by concomitant use of rivaroxaban and amiodarone |
topic | Case Report |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6109521/ https://www.ncbi.nlm.nih.gov/pubmed/30159173 http://dx.doi.org/10.1155/2018/1650716 |
work_keys_str_mv | AT oladiranoreoluwa ararecaseofspontaneouscardiactamponadeinducedbyconcomitantuseofrivaroxabanandamiodarone AT segaljared ararecaseofspontaneouscardiactamponadeinducedbyconcomitantuseofrivaroxabanandamiodarone AT nwosuifeanyi ararecaseofspontaneouscardiactamponadeinducedbyconcomitantuseofrivaroxabanandamiodarone AT nazirsalik ararecaseofspontaneouscardiactamponadeinducedbyconcomitantuseofrivaroxabanandamiodarone AT oladiranoreoluwa rarecaseofspontaneouscardiactamponadeinducedbyconcomitantuseofrivaroxabanandamiodarone AT segaljared rarecaseofspontaneouscardiactamponadeinducedbyconcomitantuseofrivaroxabanandamiodarone AT nwosuifeanyi rarecaseofspontaneouscardiactamponadeinducedbyconcomitantuseofrivaroxabanandamiodarone AT nazirsalik rarecaseofspontaneouscardiactamponadeinducedbyconcomitantuseofrivaroxabanandamiodarone |