Rivaroxaban 10mg/d in severe renal failure does not prevent ischemic events in premorbid neurologic disease.

Abstract

BACKGRUND:

The direct oral anticoagulants (DOAC) are increasingly used for primary and secondary stroke prophylaxis in atrial fibrillation, although their use in patients with renal failure is problematic.

CASE REPORT:

In an 82-years old female with recurrent strokes and atrial fibrillation, the vitamin-K-antagonist was changed to rivaroxaban because of "unstable international normalized ratio (INR) values". Because of renal failure with a creatinine clearance of 32ml/min, a dosage of rivaroxaban 10mg/d was chosen. Eleven days after initiation of rivaroxaban, she was re-hospitalized because of acute onset of right-sided weakness of the upper and lower limbs.

CONCLUSIONS:

In cases of stroke, renal failure and inadequate anticoagulation it is not useful to change from vitamin-K-antagonists to "low dose" DOAC. Diligent investigations for the cause of INR-instability and continuation of vitamin-K-antagonist therapy seem to be more effective and safer since there is the opportunity of monitoring therapy and to avoid under- as well as over-dosage.

• Authors: Claudia Stöllberger, Josef Finsterer
• Journal: Neurologia i neurochirurgia polska (Neurol Neurochir Pol) Vol. 49 Issue 3 Pg. 180-2 ( 2015) ISSN: 0028-3843 [Print] Poland
• PMID: 26048606 (Publication Type: Case Reports, Journal Article)
• Copyright: Copyright © 2015 Polish Neurological Society. Published by Elsevier Urban & Partner Sp. z o.o. All rights reserved.

Chemical References

• Factor Xa Inhibitors
• Morpholines
• Thiophenes
• Rivaroxaban

Topics

• Aged, 80 and over
• Atrial Fibrillation (drug therapy)
• Factor Xa Inhibitors (administration & dosage, pharmacology)
• Female
• Humans
• Morpholines (administration & dosage, pharmacology)
• Recurrence
• Renal Insufficiency
• Rivaroxaban
• Stroke (drug therapy, prevention & control)
• Thiophenes (administration & dosage, pharmacology)