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 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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Oral anticoagulant treatment in geriatric patients with nonvalvular atrial fibrillation in the era of direct oral anticoagulant agents

European Journal of Internal Medicine ◽

10.1016/j.ejim.2014.02.003 ◽

2014 ◽

Vol 25 (5) ◽

pp. e63-e65 ◽

Cited By ~ 2

Author(s):

Marjorie Kayser ◽

Yves Frances ◽

Laurent Bonello ◽

Franck Paganelli ◽

Michael Peyrol

Keyword(s):

Atrial Fibrillation ◽

Oral Anticoagulant ◽

Geriatric Patients ◽

Direct Oral Anticoagulant ◽

Anticoagulant Treatment ◽

Nonvalvular Atrial Fibrillation ◽

Oral Anticoagulant Treatment ◽

Anticoagulant Agents

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Association between once- and twice-daily direct oral anticoagulant adherence in nonvalvular atrial fibrillation patients and rates of ischemic stroke

International Journal of Cardiology ◽

10.1016/j.ijcard.2016.03.212 ◽

2016 ◽

Vol 215 ◽

pp. 11-13 ◽

Cited By ~ 25

Author(s):

Mark J. Alberts ◽

W. Frank Peacock ◽

Larry E. Fields ◽

Thomas J. Bunz ◽

Elaine Nguyen ◽

...

Keyword(s):

Atrial Fibrillation ◽

Ischemic Stroke ◽

Oral Anticoagulant ◽

Direct Oral Anticoagulant ◽

Nonvalvular Atrial Fibrillation

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Factors That Affect Time to Switch From Warfarin to a Direct Oral Anticoagulant After Change in the Reimbursement Criteria in Patients With Atrial Fibrillation

Journal of Cardiovascular Pharmacology and Therapeutics ◽

10.1177/1074248419868996 ◽

2019 ◽

Vol 25 (1) ◽

pp. 57-64

Author(s):

Susin Park ◽

Nam Kyung Je

Keyword(s):

Atrial Fibrillation ◽

Regression Analysis ◽

Oral Anticoagulant ◽

Proportional Hazard ◽

Direct Oral Anticoagulant ◽

Hazard Regression ◽

Cox Proportional Hazard ◽

History Of ◽

Cox Proportional Hazard Regression ◽

Prior Stroke

Background: Anticoagulation therapy is recommended for stroke prevention in high-risk patients with atrial fibrillation (AF). This study aimed to estimate the time to switch from warfarin to a direct oral anticoagulant (DOAC) and identify the factors associated with it. Methods: By using claims data, we studied 7111 warfarin-using patients with nonvalvular AF who were aged ≥65 years. The Kaplan-Meier analysis was performed to estimate the time to switch from warfarin to a DOAC, and Cox proportional hazard regression analysis was used to estimate the influencing factors. Results: Approximately one-third of the patients (2403, 33.8%) switched from warfarin to a DOAC during the study period. Female sex, aged between 75 and 79 years, having a Medical Aid or Patriots and Veterans Insurance, hypertension, and history of prior stroke, and transient ischemic attack or thromboembolism (prior stroke/TIA/TE) were associated with a significantly shorter time to switch. The odds of switching to a DOAC were increased by approximately 1.2-fold in the women and 1.4-fold in the patients with prior stroke/TIA/TE. Conclusions: Approximately one-third of the warfarin-using patients switched from warfarin to a DOAC within 6 months after the change in the DOAC reimbursement criteria. In the Cox proportional hazard regression analysis, the factors that affected anticoagulant switching from warfarin to a DOAC were female sex and history of prior stroke/TIA/TE.

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Abstract WP269: Direct Oral Anticoagulant “Pseudo-Failure” vs. “True Failure” to Prevent Ischemic Stroke in Nonvalvular Atrial Fibrillation

Stroke ◽

10.1161/str.50.suppl_1.wp269 ◽

2019 ◽

Vol 50 (Suppl_1) ◽

Author(s):

Abdelrahman Beltagy ◽

Xiyan Yi ◽

Jane Y Chang ◽

Nicholas C Hilker ◽

David Z Rose

Keyword(s):

Atrial Fibrillation ◽

Ischemic Stroke ◽

Oral Anticoagulant ◽

Direct Oral Anticoagulant ◽

Nonvalvular Atrial Fibrillation

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The Risk/Benefit Analysis of Oral Anticoagulant Treatment in Atrial Fibrillation Using HAS-BLED and CHA2DS2-VASc Score

Acta Medica Marisiensis ◽

10.1515/amma-2015-0056 ◽

2015 ◽

Vol 61 (4) ◽

pp. 269-272

Author(s):

Silivastru (Cozlea) Ionela ◽

Cozlea Daniel Laurentiu ◽

Keresztesi Arthur Attila ◽

Asofie Gabriela ◽

Cozlea Laurentiu ◽

...

Keyword(s):

Atrial Fibrillation ◽

Oral Anticoagulant ◽

Thromboembolic Events ◽

Anticoagulant Treatment ◽

Bleeding Events ◽

Nonvalvular Atrial Fibrillation ◽

Oral Anticoagulant Treatment ◽

Risk Class ◽

Number Of Patients ◽

History Of

AbstractIntroduction. The purpose of this study is to evaluate the risk and the benefit of oral anticoagulant treatment in nonvalvular atrial fibrillation (AF) patients, using the two scores recommended by the guidelines: the CHA2DS2-VASc score and HAS-BLED score.Material and method. We conducted a retrospective observational study on 144 patients with nonvalvular atrial fibrillation, admitted between 1st of July 2013 and 30th September 2013 in the 3rd Medical Clinic of Tîrgu Mureș with a prospectiv follow-up at 6 months.Based on the data collected from the patient charts, the thromboembolic risk was assessed using the CHA2DS2-VASc score and the hemorrhage risk was assessed using the HAS-BLED score. At 6 months, the patients were contacted via telephone and were questioned regarding their state of health, the existence of hospitalizations in the last 6 months, the international normalized ratio (INR) value, the existence of hemorrhagic or thromboembolic events.Results. The group of patients was composed of 70 female and 74 male with the mean age of 70 ±11 years. From the total number of patients 13 (11.7%) had a history of stroke and the CHA2DS2-VASc score revealed that these 13 were in the high risk class. The presence of arterial hypertension and vascular disease were statistically associated with stroke.Hemorrhagic events were encountered in 19 patients (13.19%) and 16 of them had a higher than 3 HAS-BLED score. A history of bleeding, anemia and labile INR were the factors statistically associated with bleeding.Conclusions. The CHA2DS2-VASc score is useful in stratifying patients with AF in risk groups for thromboembolic events while the HAS-BLED score proved to be a useful tool in predicting bleeding events in anticoagulated patients.

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