title: Use of rivaroxaban in a patient with history of nephrotic syndrome and hypercoagulability.
abstract: OBJECTIVE
  Hypercoagulability, resulting in thromboembolic events, can be a life-threatening complication of nephrotic syndrome (NS). Conventional anticoagulants, such as warfarin, have been the standard of care for more than 50 years; however, the availability of target-specific oral anticoagulants (TSOACs) have provided additional options for the treatment and prevention of thromboembolic events. Documented use of the TSOACs in patients with NS and hypercoagulability is currently limited.
  
  
  METHODS
  We present the case of an 18-year-old young woman with NS and renal vein thrombosis who was readmitted with bilateral pulmonary emboli on therapeutic doses of warfarin, with a goal international normalized ratio of 2.0 to 3.0. The decision was made to transition the patient from warfarin to rivaroxaban, an oral factor Xa inhibitor.
  
  
  CONCLUSIONS
  Rivaroxaban was the first of the emerging TSOACs to be FDA approved for both prevention and treatment of venous thromboembolism. With favorable safety and efficacy data compared with warfarin in addition to a predictable pharmacokinetic profile and the lack of requirement of routine monitoring, rivaroxaban provides a useful alternative in this patient population.
  
  
  CONCLUSIONS
  While on therapeutic anticoagulation, a patient previously diagnosed with NS and renal vein thrombosis experienced pulmonary emboli on a conventional anticoagulant and was switched to a target-specific oral anticoagulant with documented completion of 6 months of therapy without recurrent thromboembolism.
authors.affiliation: University of Florida College of Pharmacy, Jacksonville, FL, USA ldupree@cop.ufl.edu.
authors.forename: Lori H
authors.initials: LH
authors.lastname: Dupree
authors.affiliation: University of Florida, Jacksonville, FL, USA.
authors.forename: Pramod
authors.initials: P
authors.lastname: Reddy
mesh_terms: D000284:Administration, Oral; D000293:Adolescent; D000925:Anticoagulants / Q000009:adverse effects / Q000627:therapeutic use*; D065427:Factor Xa Inhibitors / Q000627:therapeutic use; D005260:Female; D006801:Humans; D019934:International Normalized Ratio; D009025:Morpholines / Q000627:therapeutic use*; D009404:Nephrotic Syndrome / Q000150:complications / Q000188:drug therapy*; D011655:Pulmonary Embolism / Q000139:chemically induced; D000069552:Rivaroxaban; D013876:Thiophenes / Q000627:therapeutic use*; D019851:Thrombophilia / Q000150:complications / Q000188:drug therapy*; D054556:Venous Thromboembolism / Q000150:complications / Q000188:drug therapy*; D014859:Warfarin / Q000009:adverse effects
chemical_list: D000925:Anticoagulants; D065427:Factor Xa Inhibitors; D009025:Morpholines; D013876:Thiophenes; D014859:Warfarin; D000069552:Rivaroxaban
keywords: anticoagulants; disease management; hematology; internal medicine; nephrology