Direct-Acting Oral Anticoagulants: Less is not always more

We report a case in which self-prescribed dose reduction of the orally active, direct factor Xa inhibitor, Rivaroxaban, was associated with the unusual thrombo-embolic complication of acute ST-segment elevation myocardial infarction (STEMI) in the setting of a fluctuating renal function and estimated glomerular filtration falling in and out of the range where dose reduction of Rivaroxaban is suggested. The case highlights the importance of dosing of Rivaroxaban in those patients who sit around the recommended dosage regimen cut offs as they are well known to be at risk of bleeding should their CrCl fall <30, but they also appear at risk of under-dosing should their CrCl improve. Due to the above-mentioned issue, careful consideration should be given to either alternative choices or close renal function monitoring, to avoid potentially life-threatening complications due to under dosing of new oral anticoagulants.
Source: Cor et Vasa - Category: Cardiology Source Type: research