Details

Autor(en) / Beteiligte

• Ing Lorenzini, Kuntheavy
• Daali, Youssef
• Fontana, Pierre
• Desmeules, Jules
• Samer, Caroline

Titel

Rivaroxaban-Induced Hemorrhage Associated with ABCB1 Genetic Defect

Ist Teil von

• Frontiers in pharmacology, 2016-12, Vol.7, p.494-494

Ort / Verlag

Switzerland: Frontiers Media S.A

Erscheinungsjahr

2016

Quelle

EZB Electronic Journals Library

Beschreibungen/Notizen

• We report a patient who presented a non-ST segment elevation myocardial infarction in the context of severe normocytic hypochromic anemia related to gastrointestinal bleeding, 3 months after switching anticoagulant from the vitamin K antagonist acenocoumarol to the direct oral anticoagulant rivaroxaban. High levels of both anti-Xa activity and rivaroxaban plasma concentrations were measured despite rivaroxaban withdrawal, suggesting reduced elimination/drug clearance. Estimated half-life was 2-3 times longer than usually reported. The patient is a homozygous carrier of variant alleles, which could have participated to reduced elimination of rivaroxaban. Furthermore, CYP3A4/5 phenotyping showed moderately reduced enzyme activity. Drug-drug interaction with simvastatin may have contributed to decreased rivaroxaban elimination. Although in the present case moderate acute renal failure probably played a role, more clinical data are required to elucidate the impact of polymorphism on rivaroxaban pharmacokinetics and bleeding complications.