title: 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.affiliation: From the Departments of *Anesthesiology and Intensive Care, †Neurosurgery, and ‡Hematology, and §Emergency Unit, University Hospital of Clermont-Ferrand, Clermont-Ferrand, France; and ‖Department of Anesthesiology and Intensive Care, Cochin University Hospital, Paris, France.
authors.forename: Sophie
authors.initials: S
authors.lastname: Kauffmann
authors.forename: Russell
authors.initials: R
authors.lastname: Chabanne
authors.forename: Aurélien
authors.initials: A
authors.lastname: Coste
authors.forename: François
authors.initials: F
authors.lastname: Longeras
authors.forename: Thomas
authors.initials: T
authors.lastname: Sinegre
authors.forename: Jeannot
authors.initials: J
authors.lastname: Schmidt
authors.forename: Charles-Marc
authors.initials: CM
authors.lastname: Samama
authors.forename: Jean-Michel
authors.initials: JM
authors.lastname: Constantin
authors.forename: Aurélien
authors.initials: A
authors.lastname: Lebreton
mesh_terms: D000368:Aged; D000925:Anticoagulants / Q000008:administration & dosage; D001777:Blood Coagulation / Q000187:drug effects; D001779:Blood Coagulation Factors / Q000627:therapeutic use*; D001780:Blood Coagulation Tests; D002543:Cerebral Hemorrhage / Q000139:chemically induced / Q000188:drug therapy*; D065427:Factor Xa Inhibitors / Q000009:adverse effects*; D006408:Hematoma, Subdural / Q000139:chemically induced / Q000628:therapy; D006801:Humans; D008297:Male; D000069552:Rivaroxaban / Q000009:adverse effects*; D013917:Thrombin / Q000096:biosynthesis
chemical_list: D000925:Anticoagulants; D001779:Blood Coagulation Factors; D065427:Factor Xa Inhibitors; C025667:prothrombin complex concentrates; D000069552:Rivaroxaban; D013917:Thrombin