Managing Subdural Bleeding Associated With Rivaroxaban: A Series of 3 Cases
Objective: To report 3 cases of subdural bleeding associated with rivaroxaban managed by 3-factor prothrombin complex concentrate (PCC3). Case Summaries: Case 1 presented with a 1-cm thick subdural hematoma (SDH) 12 hours after her last dose of rivaroxaban. Case 2 presented with a right 1-cm acute r...
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| Veröffentlicht in: | Journal of pharmacy practice 2016-06, Vol.29 (3), p.257-262 |
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| creator | Faust, Andrew C. Woodard, Sarah Koehl, Jennifer L. Mees, William Steinke, Douglas Denetclaw, Tina Harrach |
| description | Objective:
To report 3 cases of subdural bleeding associated with rivaroxaban managed by 3-factor prothrombin complex concentrate (PCC3).
Case Summaries:
Case 1 presented with a 1-cm thick subdural hematoma (SDH) 12 hours after her last dose of rivaroxaban. Case 2 presented with a right 1-cm acute right SDH with 2 to 3 mm of midline shift 24 hours after his last dose of rivaroxaban. Case 3 presented with a 1.8-cm thick right cerebral convexity hematoma 12 hours after her last dose of rivaroxaban. All patients received 23 to 35 units/kg PCC3 with 1 to 3 units of fresh frozen plasm (FFP) and demonstrated no progression in lesions measured by repeat computed tomography (CT). Two patients were discharged to rehabilitation facilities and 1 patient ultimately died due to the location of the lesion.
Discussion:
Rivaroxaban has no specific antidote. Current bleeding management strategies are based on expert opinion. The risks and benefits for differing strategies are unclear, and no clinical experience has been reported to date. These cases begin to illuminate differences among choices for managing bleeding associated with Xa inhibitors.
Conclusion:
In this case series, 25 to 35 units/kilogram PCC3 and FFP 1 to 3 units ceased rivaroxaban-associated bleeding without thrombogenic complications. |
| doi_str_mv | 10.1177/0897190015627116 |
| format | Article |
| fullrecord | <record><control><sourceid>proquest_cross</sourceid><recordid>TN_cdi_proquest_miscellaneous_1789032927</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><sage_id>10.1177_0897190015627116</sage_id><sourcerecordid>1789032927</sourcerecordid><originalsourceid>FETCH-LOGICAL-c205t-420e8aecaccf996008caf41392e7f45257031fdd99d700d3dad222a1533de01b3</originalsourceid><addsrcrecordid>eNp1kM1Lw0AQxRdRbK3ePUmOXqIzu0k2e6ylfkBF8AOPYbK7qSlpUncT0f_ehFYPgqeBeb_34D3GThEuEKW8hFRJVAAYJ1wiJntsjLHAEJWQ-2w8yOGgj9iR9ysAjpHgh2zEE5nKRKRjltxTTcuyXgZPXW46R1VwVVlrhs_U-0aX1FoTvJbtW_BYfpBrPimn-pgdFFR5e7K7E_ZyPX-e3YaLh5u72XQRag5xG0YcbEpWk9aFUglAqqmIUChuZRHFPJYgsDBGKSMBjDBkOOfUdxDGAuZiws63uRvXvHfWt9m69NpWFdW26XyGMlUguOKyR2GLatd472yRbVy5JveVIWTDWtnftXrL2S69y9fW_Bp-5umBcAt4Wtps1XSu7tv-H_gNYOVwSA</addsrcrecordid><sourcetype>Aggregation Database</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>1789032927</pqid></control><display><type>article</type><title>Managing Subdural Bleeding Associated With Rivaroxaban: A Series of 3 Cases</title><source>MEDLINE</source><source>SAGE Complete A-Z List</source><creator>Faust, Andrew C. ; Woodard, Sarah ; Koehl, Jennifer L. ; Mees, William ; Steinke, Douglas ; Denetclaw, Tina Harrach</creator><creatorcontrib>Faust, Andrew C. ; Woodard, Sarah ; Koehl, Jennifer L. ; Mees, William ; Steinke, Douglas ; Denetclaw, Tina Harrach</creatorcontrib><description>Objective:
To report 3 cases of subdural bleeding associated with rivaroxaban managed by 3-factor prothrombin complex concentrate (PCC3).
Case Summaries:
Case 1 presented with a 1-cm thick subdural hematoma (SDH) 12 hours after her last dose of rivaroxaban. Case 2 presented with a right 1-cm acute right SDH with 2 to 3 mm of midline shift 24 hours after his last dose of rivaroxaban. Case 3 presented with a 1.8-cm thick right cerebral convexity hematoma 12 hours after her last dose of rivaroxaban. All patients received 23 to 35 units/kg PCC3 with 1 to 3 units of fresh frozen plasm (FFP) and demonstrated no progression in lesions measured by repeat computed tomography (CT). Two patients were discharged to rehabilitation facilities and 1 patient ultimately died due to the location of the lesion.
Discussion:
Rivaroxaban has no specific antidote. Current bleeding management strategies are based on expert opinion. The risks and benefits for differing strategies are unclear, and no clinical experience has been reported to date. These cases begin to illuminate differences among choices for managing bleeding associated with Xa inhibitors.
Conclusion:
In this case series, 25 to 35 units/kilogram PCC3 and FFP 1 to 3 units ceased rivaroxaban-associated bleeding without thrombogenic complications.</description><identifier>ISSN: 0897-1900</identifier><identifier>EISSN: 1531-1937</identifier><identifier>DOI: 10.1177/0897190015627116</identifier><identifier>PMID: 26787638</identifier><language>eng</language><publisher>Los Angeles, CA: SAGE Publications</publisher><subject>Aged ; Aged, 80 and over ; Animals ; Blood Coagulation Factors - therapeutic use ; Disease Management ; Factor Xa Inhibitors - adverse effects ; Female ; Hematoma, Subdural - chemically induced ; Hematoma, Subdural - diagnosis ; Hematoma, Subdural - drug therapy ; Hemorrhage - chemically induced ; Hemorrhage - diagnosis ; Hemorrhage - drug therapy ; Humans ; Male ; Rivaroxaban - adverse effects</subject><ispartof>Journal of pharmacy practice, 2016-06, Vol.29 (3), p.257-262</ispartof><rights>The Author(s) 2016</rights><rights>The Author(s) 2016.</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><cites>FETCH-LOGICAL-c205t-420e8aecaccf996008caf41392e7f45257031fdd99d700d3dad222a1533de01b3</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://journals.sagepub.com/doi/pdf/10.1177/0897190015627116$$EPDF$$P50$$Gsage$$H</linktopdf><linktohtml>$$Uhttps://journals.sagepub.com/doi/10.1177/0897190015627116$$EHTML$$P50$$Gsage$$H</linktohtml><link.rule.ids>314,780,784,21818,27923,27924,43620,43621</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/26787638$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Faust, Andrew C.</creatorcontrib><creatorcontrib>Woodard, Sarah</creatorcontrib><creatorcontrib>Koehl, Jennifer L.</creatorcontrib><creatorcontrib>Mees, William</creatorcontrib><creatorcontrib>Steinke, Douglas</creatorcontrib><creatorcontrib>Denetclaw, Tina Harrach</creatorcontrib><title>Managing Subdural Bleeding Associated With Rivaroxaban: A Series of 3 Cases</title><title>Journal of pharmacy practice</title><addtitle>J Pharm Pract</addtitle><description>Objective:
To report 3 cases of subdural bleeding associated with rivaroxaban managed by 3-factor prothrombin complex concentrate (PCC3).
Case Summaries:
Case 1 presented with a 1-cm thick subdural hematoma (SDH) 12 hours after her last dose of rivaroxaban. Case 2 presented with a right 1-cm acute right SDH with 2 to 3 mm of midline shift 24 hours after his last dose of rivaroxaban. Case 3 presented with a 1.8-cm thick right cerebral convexity hematoma 12 hours after her last dose of rivaroxaban. All patients received 23 to 35 units/kg PCC3 with 1 to 3 units of fresh frozen plasm (FFP) and demonstrated no progression in lesions measured by repeat computed tomography (CT). Two patients were discharged to rehabilitation facilities and 1 patient ultimately died due to the location of the lesion.
Discussion:
Rivaroxaban has no specific antidote. Current bleeding management strategies are based on expert opinion. The risks and benefits for differing strategies are unclear, and no clinical experience has been reported to date. These cases begin to illuminate differences among choices for managing bleeding associated with Xa inhibitors.
Conclusion:
In this case series, 25 to 35 units/kilogram PCC3 and FFP 1 to 3 units ceased rivaroxaban-associated bleeding without thrombogenic complications.</description><subject>Aged</subject><subject>Aged, 80 and over</subject><subject>Animals</subject><subject>Blood Coagulation Factors - therapeutic use</subject><subject>Disease Management</subject><subject>Factor Xa Inhibitors - adverse effects</subject><subject>Female</subject><subject>Hematoma, Subdural - chemically induced</subject><subject>Hematoma, Subdural - diagnosis</subject><subject>Hematoma, Subdural - drug therapy</subject><subject>Hemorrhage - chemically induced</subject><subject>Hemorrhage - diagnosis</subject><subject>Hemorrhage - drug therapy</subject><subject>Humans</subject><subject>Male</subject><subject>Rivaroxaban - adverse effects</subject><issn>0897-1900</issn><issn>1531-1937</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2016</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNp1kM1Lw0AQxRdRbK3ePUmOXqIzu0k2e6ylfkBF8AOPYbK7qSlpUncT0f_ehFYPgqeBeb_34D3GThEuEKW8hFRJVAAYJ1wiJntsjLHAEJWQ-2w8yOGgj9iR9ysAjpHgh2zEE5nKRKRjltxTTcuyXgZPXW46R1VwVVlrhs_U-0aX1FoTvJbtW_BYfpBrPimn-pgdFFR5e7K7E_ZyPX-e3YaLh5u72XQRag5xG0YcbEpWk9aFUglAqqmIUChuZRHFPJYgsDBGKSMBjDBkOOfUdxDGAuZiws63uRvXvHfWt9m69NpWFdW26XyGMlUguOKyR2GLatd472yRbVy5JveVIWTDWtnftXrL2S69y9fW_Bp-5umBcAt4Wtps1XSu7tv-H_gNYOVwSA</recordid><startdate>201606</startdate><enddate>201606</enddate><creator>Faust, Andrew C.</creator><creator>Woodard, Sarah</creator><creator>Koehl, Jennifer L.</creator><creator>Mees, William</creator><creator>Steinke, Douglas</creator><creator>Denetclaw, Tina Harrach</creator><general>SAGE Publications</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope></search><sort><creationdate>201606</creationdate><title>Managing Subdural Bleeding Associated With Rivaroxaban</title><author>Faust, Andrew C. ; Woodard, Sarah ; Koehl, Jennifer L. ; Mees, William ; Steinke, Douglas ; Denetclaw, Tina Harrach</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c205t-420e8aecaccf996008caf41392e7f45257031fdd99d700d3dad222a1533de01b3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2016</creationdate><topic>Aged</topic><topic>Aged, 80 and over</topic><topic>Animals</topic><topic>Blood Coagulation Factors - therapeutic use</topic><topic>Disease Management</topic><topic>Factor Xa Inhibitors - adverse effects</topic><topic>Female</topic><topic>Hematoma, Subdural - chemically induced</topic><topic>Hematoma, Subdural - diagnosis</topic><topic>Hematoma, Subdural - drug therapy</topic><topic>Hemorrhage - chemically induced</topic><topic>Hemorrhage - diagnosis</topic><topic>Hemorrhage - drug therapy</topic><topic>Humans</topic><topic>Male</topic><topic>Rivaroxaban - adverse effects</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Faust, Andrew C.</creatorcontrib><creatorcontrib>Woodard, Sarah</creatorcontrib><creatorcontrib>Koehl, Jennifer L.</creatorcontrib><creatorcontrib>Mees, William</creatorcontrib><creatorcontrib>Steinke, Douglas</creatorcontrib><creatorcontrib>Denetclaw, Tina Harrach</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><jtitle>Journal of pharmacy practice</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Faust, Andrew C.</au><au>Woodard, Sarah</au><au>Koehl, Jennifer L.</au><au>Mees, William</au><au>Steinke, Douglas</au><au>Denetclaw, Tina Harrach</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Managing Subdural Bleeding Associated With Rivaroxaban: A Series of 3 Cases</atitle><jtitle>Journal of pharmacy practice</jtitle><addtitle>J Pharm Pract</addtitle><date>2016-06</date><risdate>2016</risdate><volume>29</volume><issue>3</issue><spage>257</spage><epage>262</epage><pages>257-262</pages><issn>0897-1900</issn><eissn>1531-1937</eissn><abstract>Objective:
To report 3 cases of subdural bleeding associated with rivaroxaban managed by 3-factor prothrombin complex concentrate (PCC3).
Case Summaries:
Case 1 presented with a 1-cm thick subdural hematoma (SDH) 12 hours after her last dose of rivaroxaban. Case 2 presented with a right 1-cm acute right SDH with 2 to 3 mm of midline shift 24 hours after his last dose of rivaroxaban. Case 3 presented with a 1.8-cm thick right cerebral convexity hematoma 12 hours after her last dose of rivaroxaban. All patients received 23 to 35 units/kg PCC3 with 1 to 3 units of fresh frozen plasm (FFP) and demonstrated no progression in lesions measured by repeat computed tomography (CT). Two patients were discharged to rehabilitation facilities and 1 patient ultimately died due to the location of the lesion.
Discussion:
Rivaroxaban has no specific antidote. Current bleeding management strategies are based on expert opinion. The risks and benefits for differing strategies are unclear, and no clinical experience has been reported to date. These cases begin to illuminate differences among choices for managing bleeding associated with Xa inhibitors.
Conclusion:
In this case series, 25 to 35 units/kilogram PCC3 and FFP 1 to 3 units ceased rivaroxaban-associated bleeding without thrombogenic complications.</abstract><cop>Los Angeles, CA</cop><pub>SAGE Publications</pub><pmid>26787638</pmid><doi>10.1177/0897190015627116</doi><tpages>6</tpages></addata></record> |
| fulltext | fulltext |
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| ispartof | Journal of pharmacy practice, 2016-06, Vol.29 (3), p.257-262 |
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| language | eng |
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| source | MEDLINE; SAGE Complete A-Z List |
| subjects | Aged Aged, 80 and over Animals Blood Coagulation Factors - therapeutic use Disease Management Factor Xa Inhibitors - adverse effects Female Hematoma, Subdural - chemically induced Hematoma, Subdural - diagnosis Hematoma, Subdural - drug therapy Hemorrhage - chemically induced Hemorrhage - diagnosis Hemorrhage - drug therapy Humans Male Rivaroxaban - adverse effects |
| title | Managing Subdural Bleeding Associated With Rivaroxaban: A Series of 3 Cases |
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