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...

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Autores principales: Oladiran, Oreoluwa, Segal, Jared, Nwosu, Ifeanyi, Nazir, Salik
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
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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.
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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
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