Favorable outcome of rivaroxaban-associated intracerebral hemorrhage reversed by 4-factor prothrombin complex concentrate: impact on thrombin generation.

Abstract

The management of life-threatening bleeding associated with rivaroxaban remains a challenge for physicians due to the lack of evidence about clinically effective options for anticoagulation reversal. We report a favorable outcome in a patient receiving rivaroxaban prophylaxis, who developed a spontaneous subdural hematoma treated by a surgical evacuation and administration of 4-factor prothrombin complex concentrate. Classical coagulation variables were associated with impaired thrombin generation. Reversal with prothrombin complex concentrates improved all thrombin generation measures. Thrombin generation tests may be suitable for assessing the clinical utility of reversal drugs on rivaroxaban-induced coagulopathy.

• Authors: Sophie Kauffmann, Russell Chabanne, Aurélien Coste, François Longeras, Thomas Sinegre, Jeannot Schmidt, Charles-Marc Samama, Jean-Michel Constantin, Aurélien Lebreton
• Journal: A & A case reports (A A Case Rep) Vol. 4 Issue 11 Pg. 151-4 (Jun 01 2015) ISSN: 2325-7237 [Electronic] United States
• PMID: 26035221 (Publication Type: Case Reports, Journal Article)

Chemical References

• Anticoagulants
• Blood Coagulation Factors
• Factor Xa Inhibitors
• prothrombin complex concentrates
• Rivaroxaban
• Thrombin

Topics

• Aged
• Anticoagulants (administration & dosage)
• Blood Coagulation (drug effects)
• Blood Coagulation Factors (therapeutic use)
• Blood Coagulation Tests
• Cerebral Hemorrhage (chemically induced, drug therapy)
• Factor Xa Inhibitors (adverse effects)
• Hematoma, Subdural (chemically induced, therapy)
• Humans
• Male
• Rivaroxaban (adverse effects)
• Thrombin (biosynthesis)