Background: The prevalence of both atrial fibrillation (FA) and diabetes mellitus (DM) is increasing and they often occur together and constitute a high risk of thrombosis. Rivaroxaban is a Factor Xa inhibitor with a ...Background: The prevalence of both atrial fibrillation (FA) and diabetes mellitus (DM) is increasing and they often occur together and constitute a high risk of thrombosis. Rivaroxaban is a Factor Xa inhibitor with a rapid onset and disappearance of action after oral administration;it acts by inhibiting the active form of the coagulation factor. In order to reflect the effect of the action of Rivaroxaban, we used the prothrombin time (PT);however, it′s not the most accurate, but it is the one available in our community. Methods: This was a prospective, randomized, analyst-blinded, parallel group clinical study to verify the efficacy of Rivaroxaban Leti 20 mg (RL) (12 volunteers vs Rivaroxaban Bayer 20 mg (RB) (13 volunteers). The variables were determination of PT and Partial Thromboplastin Time (aPTT) at baseline and at 24, 48 and 72 hours after administering a daily dose of 20 mg for three days. The determination was carried out with the IDG method (Integrated Diagnostics Group Sanzay Corporation) with an International Sensitivity Index (ISI) of 1.17 PT and aPTT were taken before the first dose, and then, every day during the next 3 days, three hours after the ingestion of their daily dose at 7 am. Results: The 25 healthy volunteers were similar in age, BMI, and SBP/DBP level with a greater number of men in the Bayer group. The efficacy of rivaroxaban was similar in both groups with prolongation of PTT to the 2nd day of treatment with PT, and percentage changes from baseline (14.46 ± 0.97 for RB vs 14.17 ± 0.94 RL p: 0.45), PTT results and percentage changes from the base (RB: 34 ± 4.53 RL: 33.46 ± 2.82). The safety of rivaroxaban was good in both groups with no serious adverse events. The equivalence in the logarithmically transformed PT result (ln) on day two, Mean and CI (90%) 99.2 (94.4-104) and 100 (99.5-100.8);neither the means nor the 90% confidence intervals of the PT variable transformed logarithmically to ensure its normality, were far from the 80%-125% allowed for declaration of similarity. Conclusion: The test formulation Rivaroxaban Asarap<sup>?</sup> 20 mg, manufactured by Leti Laboratories, is interchangeable or bioequivalent in clinical and laboratory response to the reference formulation Xarelto<sup>?</sup> manufactured by Bayer Laboratories.展开更多
Heparin-induced thrombocytopenia(HIT) is a relatively infrequent complication of heparin administration. HIT can cause devastating thrombosis, making it one of the most serious adverse drug reactions encountered in cl...Heparin-induced thrombocytopenia(HIT) is a relatively infrequent complication of heparin administration. HIT can cause devastating thrombosis, making it one of the most serious adverse drug reactions encountered in clinical practice. We successfully treated a case of severe HIT presenting with thrombosis and life-threatening bleeding complications with intravenous immunoglobulin(IVIG), platelet transfusion and oral anticoagulant Rivaroxaban. In this case, we considered that IVIG played the most important role by preventing further thrombosis, increasing the platelet count, and ensuring the efficacy of Rivaroxaban. We therefore suggest that IVIG might be the optimal treatment for patients with this urgent condition.展开更多
Objective:To explore the effect of ulinastatin(UTI) continuous infusion combined Rivaroxaban on the deep vein thrombosis in patients undergoing major orthopedic surgery.Methods:Forty-five patients undergoing major ort...Objective:To explore the effect of ulinastatin(UTI) continuous infusion combined Rivaroxaban on the deep vein thrombosis in patients undergoing major orthopedic surgery.Methods:Forty-five patients undergoing major orthopedic surgery were randomly divided into three groups:ulinastatin continuous infusion(Uc) group,ulinastatin single injection(Us) group and control(C) group.All patients received patient-controlled intravenous analgesia(PCIA) after operation,and took Rivaroxaban 10 mg orally 12 hours after operation.Ulinastatin(5 000 U/kg)was given intravenously to both Uc and Us groups preoperatively.Group C was given isometric normal saline,group Uc was pumped UTI continuous intravenously at the end of surgery(10 000U/kg) to 48 hours through PCIA pump.The values of hematocrit(HCT),thrombomodulin(TM),Interleukin(IL-6),thrombin-antithrombin complex(TAT),D-Dimer(D-D) were normally tested before surgery(T1),at the end of the surgery(T2),12 hours(T3).24 hours(T4) and 48 hours(T5)after surgery.Results:Compared with T1,there was an upward tendency in TM,IL-6,TAT,and D-D after operation in group C group(P <0.05).The values of them were significandy increased from nearly 24-hour after surgery in Us group(P<0.05).In group Uc.there were no significant changes in these indices after operation(P>0.05).Conclusions:During the perioperative period,ulinastatin continuous infusion combined Rivaroxaban can correct blood hypercoagulability through different approaches in patients undergoing major orthopedic surgery.展开更多
BACKGROUND Rivaroxaban is a non-vitamin K antagonist oral anticoagulant that does not require coagulation monitoring based on current recommendations. Our goal is to explore whether routine coagulation monitoring shou...BACKGROUND Rivaroxaban is a non-vitamin K antagonist oral anticoagulant that does not require coagulation monitoring based on current recommendations. Our goal is to explore whether routine coagulation monitoring should not be required for all patients receiving oral rivaroxaban, what relationship between routine coagulation abnormalities and bleeding, and how to deal with the above clinical situations through our case and review of the literature.CASE SUMMARY We report a 67-year-old woman with a history of atrial fibrillation who presented to the hospital with worsening dyspnea and cough. Based on electrocardiogram,venous compression ultrasonography, and computed tomography pulmonary angiography, the diagnosis of atrial fibrillation, deep venous thrombosis, and acute pulmonary embolism was confirmed. Her coagulation assays and renal function were normal on admission; she was not underweight, did not have a history of hemorrhagic disease, and her CHA2 DS2-VAS, HAS-BLED, and simplified Pulmonary Embolism Severity Index scores were 3, 0, and 0,respectively. Oral rivaroxaban(15 mg twice daily) was administered. The following day, she presented gastrointestinal and gum bleeding, combined with coagulation abnormalities. Following cessation of rivaroxaban, her bleeding stopped and tests improved over the next 2 d. Rivaroxaban was begun again 3 d after recovery. However, she again presented with gastrointestinal and gum bleeding and the abnormal tests, and the therapy was discontinued. At 30-d follow-up after discharge, she presented normal coagulation tests without bleeding.CONCLUSION Although current guidelines recommend that using non-vitamin K antagonist oral anticoagulants including rivaroxaban do not require coagulation monitoring,a small number of patients may develop routine coagulation test changes and bleeding during rivaroxaban therapy, especially in the elderly. Clinicians should pay attention to these patients and further obtain evidence in practice.展开更多
This study was intended to investigate into the incidence rates of deep vein thrombosis (DVT) in patients who used prophylactic antithrombotic medications after total knee arthroplasty (TKA), and to compare clinical r...This study was intended to investigate into the incidence rates of deep vein thrombosis (DVT) in patients who used prophylactic antithrombotic medications after total knee arthroplasty (TKA), and to compare clinical results in groups treated with Rivaroxaban versus Dalteparin sodium as prophylactic antithrombotic medications. This prospective study was performed in 300 patients who underwent TKA between November 2011 and December 2012. The prophylactic therapy was given to 150 patients in Rivaroxaban group and Dalteparin sodium group, respectively. In addition, intermittent compression pump and stocking were used in all the groups immediately after TKA. In order to determine the incidence of DVT, color Doppler ultrasonography, D-dimer, and clinical symptom examination were conducted. There were 17 cases (11.3%) of DVT in Rivaroxaban group and 18 cases (12.0%) of DVT in Dalteparin sodium group after TKA, and no significant difference was seen between both groups. Between patients with DVT and those without DVT after TKA at 4 days in both groups, there was a significant difference in the swelling indices. Moreover, a significant difference was observed in the evaluation of bruise. The early signs of DVT after TKA are unknown, however, some initial clinical signs such as swelling have been observed. After using the said prophylactic drugs, the lower incidence of DVT was seen, and there was no difference between the types of drugs. Pharmacological therapy (either Rivaroxaban or Dalteparin sodium) after TKA is considered effective for DVT prevention. There is also a need to consider constant monitoring of clinical symptoms.展开更多
BACKGROUND Heparin is commonly recommended for warfarin-induced skin necrosis;however, there is currently no established therapy for this disease. We present a serious case of warfarin-induced skin necrosis that was s...BACKGROUND Heparin is commonly recommended for warfarin-induced skin necrosis;however, there is currently no established therapy for this disease. We present a serious case of warfarin-induced skin necrosis that was successfully treated with oral rivaroxaban, a factor Xa inhibitor.CASE SUMMARY A 48-year-old woman was admitted to the hospital for cellulitis of the right lower extremity. After antibiotic treatment, she developed pain and swelling of the left lower extremity, and deep vein thrombosis of both lower extremities was diagnosed. She was treated with a continuous heparin injection;subsequently,oral warfarin was concomitantly administered. Heparin was terminated after the therapeutic range was reached. On the following day, the patient had swelling and pain in the left lower extremity. In addition to decrease in protein S activity due to systemic lupus erythematosus, warfarin also reduced protein C activity,resulting in further hypercoagulation and skin necrosis. Warfarin was discontinued, and continuous heparin injection was resumed. Although the patient had to undergo amputation of the distal end of her left foot, continuous heparin injection was switched to oral rivaroxaban, and she was eventually discharged from the hospital in remission.CONCLUSION Administration of direct oral anticoagulants instead of warfarin is important in patients with decreased protein S and C activity.展开更多
BACKGROUND Novel oral anticoagulants(NOACs)are commonly used for the anticoagulation of patients with atrial fibrillation.Reports of thrombocytopenic toxicity of NOACs are limited.In this report,we present a case of t...BACKGROUND Novel oral anticoagulants(NOACs)are commonly used for the anticoagulation of patients with atrial fibrillation.Reports of thrombocytopenic toxicity of NOACs are limited.In this report,we present a case of thrombocytopenia likely induced by rivaroxaban,which is an extremely rare adverse drug reaction.CASE SUMMARY A 70-year-old man presented to the cardiovascular department with a chief complaint of intermittent chest tightness and dyspnea over the last five years.Vital signs were within normal limits at presentation,with a heart rate of 65 beats/min,blood pressure of 138/78 mmHg,respiratory rate of 19 breaths/min,and temperature of 36.1°C.Laboratory tests indicated a platelet count of 163×109/L on admission.Anticoagulant therapy with rivaroxaban,a NOAC,was started on the second day of hospitalization.The platelet count decreased to 30×109/L on hospital day 11 and then 10×109/L on day 12.Rivaroxaban was stopped on day 13 when the platelet count decreased to 5×109/L.After the cessation of rivaroxaban,the platelet count returned to normal.The patient was diagnosed with thrombocytopenia,which was likely induced by rivaroxaban.The incidence of thrombocytopenic toxicity of NOACs is extremely low.CONCLUSION Thrombocytopenia during anticoagulation therapy may be associated with a high risk of life-threatening bleeding.For elderly patients,changes in platelet count should be carefully monitored at the beginning of NOAC treatment,and we should be on the alert for bleeding events as well.展开更多
BACKGROUND Most of the randomized clinical trials that led to the wide use of non-vitamin K antagonist oral anticoagulants for stroke prevention in patients with atrial fibrillation(AF)originated from western countrie...BACKGROUND Most of the randomized clinical trials that led to the wide use of non-vitamin K antagonist oral anticoagulants for stroke prevention in patients with atrial fibrillation(AF)originated from western countries.AIM To systematically review and quantitatively synthesize the real-world data regarding the efficacy and safety of dabigatran,rivaroxaban,and apixaban compared to warfarin for stroke prevention in Asian patients with non-valvular AF.METHODS Medline,Cochrane,and ClinicalTrial.gov databases were reviewed.A randomeffect model meta-analysis was used and I-square was utilized to assess the heterogeneity.The primary outcome was ischemic stroke.The secondary outcomes were all-cause mortality,major bleeding,intracranial hemorrhage,and gastrointestinal bleeding.RESULTS Twelve studies from East Asia or Southeast Asia and 441450 patients were included.Dabigatran,rivaroxaban,and apixaban were associated with a significant reduction in the incidence of ischemic stroke[hazard ratio(HR)=0.78,95%confidence interval(CI):0.65-0.94;HR=0.79,95%CI:0.74-0.85,HR=0.70,95%CI:0.62-0.78;respectively],all-cause mortality(HR=0.68,95%CI:0.56-0.83;HR=0.66,95%CI:0.52-0.84;HR=0.66,95%CI:0.49-0.90;respectively),and major bleeding(HR=0.61,95%CI:0.54-0.69;HR=0.70,95%CI:0.54-0.90;HR=0.58,95%CI:0.43-0.78;respectively)compared to warfarin.CONCLUSION Dabigatran,rivaroxaban,and apixaban appear to be superior to warfarin in both efficacy and safety in Asians with non-valvular AF.展开更多
Purpose: To investigate the clinical characteristics of combined prophylaxis of rivaroxaban (Xarelto?) and mechanical therapy (foot sole pump, antiembolism stocking) after total knee replacement arthroplasty, for prev...Purpose: To investigate the clinical characteristics of combined prophylaxis of rivaroxaban (Xarelto?) and mechanical therapy (foot sole pump, antiembolism stocking) after total knee replacement arthroplasty, for prevention of deep vein thrombosis (DVT). Materials and Methods: The subjects of this study were 110 patients who underwent total knee replacement arthroplasty (TKA) between November 2011 and May 2012, and were prospectively evaluated. They consisted of 13 men (11.8%) and 97 women (88.2%) with the mean age of 68.7 years (±7.9). All of the patients received 10 mg of rivaroxaban once daily for 14 days from Day 1 postoperatively, and used an intermittent pneumatic compression (IPC) pump and compression stockings immediately after the operation. To determine the presence of postoperative DVT, clinical symptoms examination, D-dimer test, color Doppler ultrasound imaging were performed to analyze the risk factors of DVT events. Results: There were a total of 13 patients (11.8%) with DVT in the distal lower limbs among the entire 110 patients. At Day 4 after the operation, a statistically significant difference was seen only in femoral swelling of several clinical symptoms between DVT group and non-DVT group (p = 0.043). D-dimer tests showed no statistically significant difference between the two groups, however with the boundary value of 0.3 mg/L, diagnostic sensitivity, specificity, positive predictability and negative predictability were equivalent to 100%, 8.2%, 12.7% and 100%, respectively. There was no significant difference between the two groups in terms of well-known risk factors including age, gender, obesity, hypertension, diabetes, smoking, and anesthesia method, and no case of pulmonary embolism was observed. Conclusion: A combination of pharmacological therapy (rivaroxaban, Xarelto?) and mechanical therapy (foot sole pump system) after TKA is considered effective for DVT prevention.展开更多
After entering 2010, as main varieties patents of the global non-peptide angiotensin II receptor antagonists （ARB） expire, strong growth of anti-hypertensive drug market will tend to slow down. In drugs acting on th...After entering 2010, as main varieties patents of the global non-peptide angiotensin II receptor antagonists （ARB） expire, strong growth of anti-hypertensive drug market will tend to slow down. In drugs acting on the cardiovascular and blood system, antithrombotie drugs will become a new attraction on the market. Antithrombotic drugs are primarily formed by the anti-platelet aggregation, coagulation system activation of plasminogen thrombolytic drugs and the like. Antiplatelet drugs have both prevention and treatment effect, are the main category of antithrombotic drugs. According to IMS Health data, in 2008, sale of anti-thrombosis drug in global market is 180 million U.S. dollars, an increase of 16 %, while in 2009 the growth rate is only 7.95%, reaching $ 19.5 billion, growth rate of antithrombotic drugs is 7.13% in the world＇ s major pharmaceutical market.展开更多
Introduction:Livedoid vasculopathy is a chronic noninflammatory skin disease secondary to hypercoagulable states.No therapeutic guideline has yet been established for livedoid vasculopathy.We herein report a case of l...Introduction:Livedoid vasculopathy is a chronic noninflammatory skin disease secondary to hypercoagulable states.No therapeutic guideline has yet been established for livedoid vasculopathy.We herein report a case of livedoid vasculopathy secondary to protein C deficiency that was successfully treated with rivaroxaban.Case presentation:A 31-year-old Thai woman who had been diagnosed with livedoid vasculopathy 10 years previously presented with a 2-month history of worsening leg ulcers and failure to respond to aspirin,colchicine,and pentoxifylline.Further investigations confirmed protein C deficiency.Rivaroxaban was initiated,and clinical improvement was achieved in 8 weeks.Discussion:When livedoid vasculopathy is confirmed by skin biopsy,additional investigations for hypercoagulable states should be performed to exclude secondary causes.Identification of the causes of livedoid vasculopathy can direct physicians to therapeutic options based on previously reported cases of successful treatment.Our patient,whose livedoid vasculopathy was caused by protein C deficiency,responded well to rivaroxaban.Conclusion:Protein C deficiency results in a hypercoagulable state,and affected patients can present with livedoid vasculopathy.The anticoagulant rivaroxaban has been beneficial in the treatment of livedoid vasculopathy.展开更多
文摘Background: The prevalence of both atrial fibrillation (FA) and diabetes mellitus (DM) is increasing and they often occur together and constitute a high risk of thrombosis. Rivaroxaban is a Factor Xa inhibitor with a rapid onset and disappearance of action after oral administration;it acts by inhibiting the active form of the coagulation factor. In order to reflect the effect of the action of Rivaroxaban, we used the prothrombin time (PT);however, it′s not the most accurate, but it is the one available in our community. Methods: This was a prospective, randomized, analyst-blinded, parallel group clinical study to verify the efficacy of Rivaroxaban Leti 20 mg (RL) (12 volunteers vs Rivaroxaban Bayer 20 mg (RB) (13 volunteers). The variables were determination of PT and Partial Thromboplastin Time (aPTT) at baseline and at 24, 48 and 72 hours after administering a daily dose of 20 mg for three days. The determination was carried out with the IDG method (Integrated Diagnostics Group Sanzay Corporation) with an International Sensitivity Index (ISI) of 1.17 PT and aPTT were taken before the first dose, and then, every day during the next 3 days, three hours after the ingestion of their daily dose at 7 am. Results: The 25 healthy volunteers were similar in age, BMI, and SBP/DBP level with a greater number of men in the Bayer group. The efficacy of rivaroxaban was similar in both groups with prolongation of PTT to the 2nd day of treatment with PT, and percentage changes from baseline (14.46 ± 0.97 for RB vs 14.17 ± 0.94 RL p: 0.45), PTT results and percentage changes from the base (RB: 34 ± 4.53 RL: 33.46 ± 2.82). The safety of rivaroxaban was good in both groups with no serious adverse events. The equivalence in the logarithmically transformed PT result (ln) on day two, Mean and CI (90%) 99.2 (94.4-104) and 100 (99.5-100.8);neither the means nor the 90% confidence intervals of the PT variable transformed logarithmically to ensure its normality, were far from the 80%-125% allowed for declaration of similarity. Conclusion: The test formulation Rivaroxaban Asarap<sup>?</sup> 20 mg, manufactured by Leti Laboratories, is interchangeable or bioequivalent in clinical and laboratory response to the reference formulation Xarelto<sup>?</sup> manufactured by Bayer Laboratories.
文摘Heparin-induced thrombocytopenia(HIT) is a relatively infrequent complication of heparin administration. HIT can cause devastating thrombosis, making it one of the most serious adverse drug reactions encountered in clinical practice. We successfully treated a case of severe HIT presenting with thrombosis and life-threatening bleeding complications with intravenous immunoglobulin(IVIG), platelet transfusion and oral anticoagulant Rivaroxaban. In this case, we considered that IVIG played the most important role by preventing further thrombosis, increasing the platelet count, and ensuring the efficacy of Rivaroxaban. We therefore suggest that IVIG might be the optimal treatment for patients with this urgent condition.
基金supported in part by Scientific Research Fund of Hainan Provincial Health Department(No.2010-83)
文摘Objective:To explore the effect of ulinastatin(UTI) continuous infusion combined Rivaroxaban on the deep vein thrombosis in patients undergoing major orthopedic surgery.Methods:Forty-five patients undergoing major orthopedic surgery were randomly divided into three groups:ulinastatin continuous infusion(Uc) group,ulinastatin single injection(Us) group and control(C) group.All patients received patient-controlled intravenous analgesia(PCIA) after operation,and took Rivaroxaban 10 mg orally 12 hours after operation.Ulinastatin(5 000 U/kg)was given intravenously to both Uc and Us groups preoperatively.Group C was given isometric normal saline,group Uc was pumped UTI continuous intravenously at the end of surgery(10 000U/kg) to 48 hours through PCIA pump.The values of hematocrit(HCT),thrombomodulin(TM),Interleukin(IL-6),thrombin-antithrombin complex(TAT),D-Dimer(D-D) were normally tested before surgery(T1),at the end of the surgery(T2),12 hours(T3).24 hours(T4) and 48 hours(T5)after surgery.Results:Compared with T1,there was an upward tendency in TM,IL-6,TAT,and D-D after operation in group C group(P <0.05).The values of them were significandy increased from nearly 24-hour after surgery in Us group(P<0.05).In group Uc.there were no significant changes in these indices after operation(P>0.05).Conclusions:During the perioperative period,ulinastatin continuous infusion combined Rivaroxaban can correct blood hypercoagulability through different approaches in patients undergoing major orthopedic surgery.
文摘BACKGROUND Rivaroxaban is a non-vitamin K antagonist oral anticoagulant that does not require coagulation monitoring based on current recommendations. Our goal is to explore whether routine coagulation monitoring should not be required for all patients receiving oral rivaroxaban, what relationship between routine coagulation abnormalities and bleeding, and how to deal with the above clinical situations through our case and review of the literature.CASE SUMMARY We report a 67-year-old woman with a history of atrial fibrillation who presented to the hospital with worsening dyspnea and cough. Based on electrocardiogram,venous compression ultrasonography, and computed tomography pulmonary angiography, the diagnosis of atrial fibrillation, deep venous thrombosis, and acute pulmonary embolism was confirmed. Her coagulation assays and renal function were normal on admission; she was not underweight, did not have a history of hemorrhagic disease, and her CHA2 DS2-VAS, HAS-BLED, and simplified Pulmonary Embolism Severity Index scores were 3, 0, and 0,respectively. Oral rivaroxaban(15 mg twice daily) was administered. The following day, she presented gastrointestinal and gum bleeding, combined with coagulation abnormalities. Following cessation of rivaroxaban, her bleeding stopped and tests improved over the next 2 d. Rivaroxaban was begun again 3 d after recovery. However, she again presented with gastrointestinal and gum bleeding and the abnormal tests, and the therapy was discontinued. At 30-d follow-up after discharge, she presented normal coagulation tests without bleeding.CONCLUSION Although current guidelines recommend that using non-vitamin K antagonist oral anticoagulants including rivaroxaban do not require coagulation monitoring,a small number of patients may develop routine coagulation test changes and bleeding during rivaroxaban therapy, especially in the elderly. Clinicians should pay attention to these patients and further obtain evidence in practice.
文摘This study was intended to investigate into the incidence rates of deep vein thrombosis (DVT) in patients who used prophylactic antithrombotic medications after total knee arthroplasty (TKA), and to compare clinical results in groups treated with Rivaroxaban versus Dalteparin sodium as prophylactic antithrombotic medications. This prospective study was performed in 300 patients who underwent TKA between November 2011 and December 2012. The prophylactic therapy was given to 150 patients in Rivaroxaban group and Dalteparin sodium group, respectively. In addition, intermittent compression pump and stocking were used in all the groups immediately after TKA. In order to determine the incidence of DVT, color Doppler ultrasonography, D-dimer, and clinical symptom examination were conducted. There were 17 cases (11.3%) of DVT in Rivaroxaban group and 18 cases (12.0%) of DVT in Dalteparin sodium group after TKA, and no significant difference was seen between both groups. Between patients with DVT and those without DVT after TKA at 4 days in both groups, there was a significant difference in the swelling indices. Moreover, a significant difference was observed in the evaluation of bruise. The early signs of DVT after TKA are unknown, however, some initial clinical signs such as swelling have been observed. After using the said prophylactic drugs, the lower incidence of DVT was seen, and there was no difference between the types of drugs. Pharmacological therapy (either Rivaroxaban or Dalteparin sodium) after TKA is considered effective for DVT prevention. There is also a need to consider constant monitoring of clinical symptoms.
文摘BACKGROUND Heparin is commonly recommended for warfarin-induced skin necrosis;however, there is currently no established therapy for this disease. We present a serious case of warfarin-induced skin necrosis that was successfully treated with oral rivaroxaban, a factor Xa inhibitor.CASE SUMMARY A 48-year-old woman was admitted to the hospital for cellulitis of the right lower extremity. After antibiotic treatment, she developed pain and swelling of the left lower extremity, and deep vein thrombosis of both lower extremities was diagnosed. She was treated with a continuous heparin injection;subsequently,oral warfarin was concomitantly administered. Heparin was terminated after the therapeutic range was reached. On the following day, the patient had swelling and pain in the left lower extremity. In addition to decrease in protein S activity due to systemic lupus erythematosus, warfarin also reduced protein C activity,resulting in further hypercoagulation and skin necrosis. Warfarin was discontinued, and continuous heparin injection was resumed. Although the patient had to undergo amputation of the distal end of her left foot, continuous heparin injection was switched to oral rivaroxaban, and she was eventually discharged from the hospital in remission.CONCLUSION Administration of direct oral anticoagulants instead of warfarin is important in patients with decreased protein S and C activity.
文摘BACKGROUND Novel oral anticoagulants(NOACs)are commonly used for the anticoagulation of patients with atrial fibrillation.Reports of thrombocytopenic toxicity of NOACs are limited.In this report,we present a case of thrombocytopenia likely induced by rivaroxaban,which is an extremely rare adverse drug reaction.CASE SUMMARY A 70-year-old man presented to the cardiovascular department with a chief complaint of intermittent chest tightness and dyspnea over the last five years.Vital signs were within normal limits at presentation,with a heart rate of 65 beats/min,blood pressure of 138/78 mmHg,respiratory rate of 19 breaths/min,and temperature of 36.1°C.Laboratory tests indicated a platelet count of 163×109/L on admission.Anticoagulant therapy with rivaroxaban,a NOAC,was started on the second day of hospitalization.The platelet count decreased to 30×109/L on hospital day 11 and then 10×109/L on day 12.Rivaroxaban was stopped on day 13 when the platelet count decreased to 5×109/L.After the cessation of rivaroxaban,the platelet count returned to normal.The patient was diagnosed with thrombocytopenia,which was likely induced by rivaroxaban.The incidence of thrombocytopenic toxicity of NOACs is extremely low.CONCLUSION Thrombocytopenia during anticoagulation therapy may be associated with a high risk of life-threatening bleeding.For elderly patients,changes in platelet count should be carefully monitored at the beginning of NOAC treatment,and we should be on the alert for bleeding events as well.
文摘BACKGROUND Most of the randomized clinical trials that led to the wide use of non-vitamin K antagonist oral anticoagulants for stroke prevention in patients with atrial fibrillation(AF)originated from western countries.AIM To systematically review and quantitatively synthesize the real-world data regarding the efficacy and safety of dabigatran,rivaroxaban,and apixaban compared to warfarin for stroke prevention in Asian patients with non-valvular AF.METHODS Medline,Cochrane,and ClinicalTrial.gov databases were reviewed.A randomeffect model meta-analysis was used and I-square was utilized to assess the heterogeneity.The primary outcome was ischemic stroke.The secondary outcomes were all-cause mortality,major bleeding,intracranial hemorrhage,and gastrointestinal bleeding.RESULTS Twelve studies from East Asia or Southeast Asia and 441450 patients were included.Dabigatran,rivaroxaban,and apixaban were associated with a significant reduction in the incidence of ischemic stroke[hazard ratio(HR)=0.78,95%confidence interval(CI):0.65-0.94;HR=0.79,95%CI:0.74-0.85,HR=0.70,95%CI:0.62-0.78;respectively],all-cause mortality(HR=0.68,95%CI:0.56-0.83;HR=0.66,95%CI:0.52-0.84;HR=0.66,95%CI:0.49-0.90;respectively),and major bleeding(HR=0.61,95%CI:0.54-0.69;HR=0.70,95%CI:0.54-0.90;HR=0.58,95%CI:0.43-0.78;respectively)compared to warfarin.CONCLUSION Dabigatran,rivaroxaban,and apixaban appear to be superior to warfarin in both efficacy and safety in Asians with non-valvular AF.
文摘Purpose: To investigate the clinical characteristics of combined prophylaxis of rivaroxaban (Xarelto?) and mechanical therapy (foot sole pump, antiembolism stocking) after total knee replacement arthroplasty, for prevention of deep vein thrombosis (DVT). Materials and Methods: The subjects of this study were 110 patients who underwent total knee replacement arthroplasty (TKA) between November 2011 and May 2012, and were prospectively evaluated. They consisted of 13 men (11.8%) and 97 women (88.2%) with the mean age of 68.7 years (±7.9). All of the patients received 10 mg of rivaroxaban once daily for 14 days from Day 1 postoperatively, and used an intermittent pneumatic compression (IPC) pump and compression stockings immediately after the operation. To determine the presence of postoperative DVT, clinical symptoms examination, D-dimer test, color Doppler ultrasound imaging were performed to analyze the risk factors of DVT events. Results: There were a total of 13 patients (11.8%) with DVT in the distal lower limbs among the entire 110 patients. At Day 4 after the operation, a statistically significant difference was seen only in femoral swelling of several clinical symptoms between DVT group and non-DVT group (p = 0.043). D-dimer tests showed no statistically significant difference between the two groups, however with the boundary value of 0.3 mg/L, diagnostic sensitivity, specificity, positive predictability and negative predictability were equivalent to 100%, 8.2%, 12.7% and 100%, respectively. There was no significant difference between the two groups in terms of well-known risk factors including age, gender, obesity, hypertension, diabetes, smoking, and anesthesia method, and no case of pulmonary embolism was observed. Conclusion: A combination of pharmacological therapy (rivaroxaban, Xarelto?) and mechanical therapy (foot sole pump system) after TKA is considered effective for DVT prevention.
文摘After entering 2010, as main varieties patents of the global non-peptide angiotensin II receptor antagonists （ARB） expire, strong growth of anti-hypertensive drug market will tend to slow down. In drugs acting on the cardiovascular and blood system, antithrombotie drugs will become a new attraction on the market. Antithrombotic drugs are primarily formed by the anti-platelet aggregation, coagulation system activation of plasminogen thrombolytic drugs and the like. Antiplatelet drugs have both prevention and treatment effect, are the main category of antithrombotic drugs. According to IMS Health data, in 2008, sale of anti-thrombosis drug in global market is 180 million U.S. dollars, an increase of 16 %, while in 2009 the growth rate is only 7.95%, reaching $ 19.5 billion, growth rate of antithrombotic drugs is 7.13% in the world＇ s major pharmaceutical market.
文摘Introduction:Livedoid vasculopathy is a chronic noninflammatory skin disease secondary to hypercoagulable states.No therapeutic guideline has yet been established for livedoid vasculopathy.We herein report a case of livedoid vasculopathy secondary to protein C deficiency that was successfully treated with rivaroxaban.Case presentation:A 31-year-old Thai woman who had been diagnosed with livedoid vasculopathy 10 years previously presented with a 2-month history of worsening leg ulcers and failure to respond to aspirin,colchicine,and pentoxifylline.Further investigations confirmed protein C deficiency.Rivaroxaban was initiated,and clinical improvement was achieved in 8 weeks.Discussion:When livedoid vasculopathy is confirmed by skin biopsy,additional investigations for hypercoagulable states should be performed to exclude secondary causes.Identification of the causes of livedoid vasculopathy can direct physicians to therapeutic options based on previously reported cases of successful treatment.Our patient,whose livedoid vasculopathy was caused by protein C deficiency,responded well to rivaroxaban.Conclusion:Protein C deficiency results in a hypercoagulable state,and affected patients can present with livedoid vasculopathy.The anticoagulant rivaroxaban has been beneficial in the treatment of livedoid vasculopathy.
