title: Reversal of rivaroxaban anticoagulation by nonactivated prothrombin complex concentrate in urgent surgery.
abstract: Rivaroxaban is a once-daily oral anticoagulant currently indicated for the prevention of stroke and systemic embolism in patients with nonvalvular atrial fibrillation. It is also indicated for the prevention and treatment of venous or pulmonary thromboembolism. Despite the known advantages of rivaroxaban over standard therapy, this treatment is not exempt from bleeding. We present the case of a 51-year-old woman with arterial hypertension and paroxysmal atrial fibrillation anticoagulated with rivaroxaban 20 mg o.d. Patient was admitted to the emergency department because of intense abdominal pain, high temperature, hypotension, tachycardia and a big tumor in the right abdominal area. The ultrasonic exam showed a big collection in the thoracic and abdominal area, compatible with hematoma. Due to clinical instability, urgent surgery was required. Based on the results of coagulation parameters (PT: 17.5 s), the time from the last rivaroxaban dose was taken, and the patient weight, nonactivated prothrombin complex concentrate at a single dose of 1000 IU was administrated intravenously 1 h before the surgery. PT value decreased to normal value (13.5 s), and surgery was performed without any bleeding complication. The management of patients treated with rivaroxaban who require urgent surgery is discussed in this report.
authors.affiliation: Hematology Service, Hospital Universitario Reina Sofía, Córdoba, Spain.
authors.forename: Carolina
authors.initials: C
authors.lastname: Chic Acevedo
authors.affiliation: Hematology Service, Hospital Universitario Reina Sofía, Córdoba, Spain.
authors.forename: Francisco
authors.initials: F
authors.lastname: Velasco
authors.affiliation: Hematology Service, Hospital Universitario Reina Sofía, Córdoba, Spain.
authors.forename: Concepción
authors.initials: C
authors.lastname: Herrera
mesh_terms: D000005:Abdomen / Q000098:blood supply* / Q000000981:diagnostic imaging / Q000601:surgery; D000284:Administration, Oral; D001281:Atrial Fibrillation / Q000150:complications*; D001777:Blood Coagulation / Q000187:drug effects; D001779:Blood Coagulation Factors / Q000008:administration & dosage*; D004334:Drug Administration Schedule; D004617:Embolism / Q000209:etiology / Q000517:prevention & control; D004630:Emergencies; D065427:Factor Xa Inhibitors / Q000008:administration & dosage / Q000009:adverse effects; D005260:Female; D006406:Hematoma / Q000139:chemically induced* / Q000175:diagnosis / Q000628:therapy; D006801:Humans; D007275:Injections, Intravenous; D008875:Middle Aged; D000069552:Rivaroxaban / Q000008:administration & dosage / Q000009:adverse effects*; D013614:Tachycardia, Paroxysmal / Q000150:complications; D014057:Tomography, X-Ray Computed; D014463:Ultrasonography
chemical_list: D001779:Blood Coagulation Factors; D065427:Factor Xa Inhibitors; C025667:prothrombin complex concentrates; D000069552:Rivaroxaban
keywords: atrial fibrillation; bleeding; hematoma; nonactivated prothrombin complex concentrate; rivaroxaban; surgery