Persistent Rivaroxaban Effect Due to Impaired Renal Clearance and Medication Effects

Abstract Rivaroxaban (Xarelto; Johnson & Johnson Services, Inc) is a direct oral anticoagulant (DOAC) that works by directly inhibiting the active site of factor Xa (FXa). Rivaroxaban is metabolized and cleared via the kidney and liver. The results of various studies have shown that patients wit...

Full description

Saved in:
Bibliographic Details
Published inLaboratory medicine Vol. 51; no. 2; pp. 211 - 216
Main Authors Milito, Chelsea, McRae, Hannah, Victor, Adrienne, Refaai, Majed A, Schmidt, Amy E
Format Journal Article
LanguageEnglish
Published US Oxford University Press 01.03.2020
Subjects
Aged
Anticoagulants
Anticoagulants (Medicine)
Atrial Flutter - complications
Atrial Flutter - drug therapy
Electrocardiography
Factor Xa Inhibitors - administration & dosage
Factor Xa Inhibitors - adverse effects
Factor Xa Inhibitors - pharmacokinetics
Hemorrhage - chemically induced
Humans
Male
Medical research
Medicine, Experimental
Metabolic Clearance Rate
Prothrombin Time
Renal Insufficiency - complications
Rivaroxaban - administration & dosage
Rivaroxaban - adverse effects
Rivaroxaban - pharmacokinetics
rivaroxaban
bleeding
prolonged PT
DOAC
anticoagulation
renal impairment
Online AccessGet full text

Cover

More Information
Summary:Abstract Rivaroxaban (Xarelto; Johnson & Johnson Services, Inc) is a direct oral anticoagulant (DOAC) that works by directly inhibiting the active site of factor Xa (FXa). Rivaroxaban is metabolized and cleared via the kidney and liver. The results of various studies have shown that patients with severe renal impairment should receive reduced dosages of rivaroxaban or another anticoagulant due to impaired clearance. Although it is not required, monitoring rivaroxaban is useful in some conditions; however, the assays required for such monitoring are not readily available. Herein, we present a case of a 68-year-old Caucasian male patient who was receiving rivaroxaban (20 mg/day) for atrial flutter and had mild renal impairment. The patient was found to have increased effect of rivaroxaban due to further impairment of renal clearance caused by several renally cleared medications. This case highlights the importance of closely examining the renal function of and medication list for a patient before starting DOACs such as rivaroxaban.
Bibliography:ObjectType-Case Study-2
SourceType-Scholarly Journals-1
ObjectType-Feature-4
content type line 23
ObjectType-Report-1
ObjectType-Article-3
ISSN:0007-5027
1943-7730
DOI:10.1093/labmed/lmz044