title: Superior mesenteric artery thrombosis after abrupt discontinuation of rivaroxaban.
abstract: We report a case of superior mesenteric artery thrombosis after the abrupt discontinuation of rivaroxaban in a 59-year-old male patient. The initial presentation was of sudden onset abdominal pain, nausea, vomiting, diarrhea, and hematochezia in the setting of recently holding rivaroxaban anticoagulation for an atrial flutter ablative procedure. Imaging revealed thrombosis of the superior mesenteric artery and acute mesenteric ischemia requiring emergent surgical intervention for embolectomy. Upon exploratory laparotomy, the bowel was found to be viable, and an embolectomy with patch angioplasty was successful without complication. This case illustrates the need for emergency medicine clinician familiarity with this possible medication adverse event with rivaroxaban.
authors.affiliation: Department of Pharmacy Services, University of California Davis Medical Center, Sacramento, CA 95817. Electronic address: chradams@ucdavis.edu.
authors.forename: Christopher B
authors.initials: CB
authors.lastname: Adams
authors.affiliation: Departments of Pharmacy and Emergency Medicine, University of Rochester Medical Center, Rochester, NY 14642.
authors.forename: Nicole M
authors.initials: NM
authors.lastname: Acquisto
authors.affiliation: Department of Emergency Medicine, University of Rochester Medical Center, Rochester, NY 14642.
authors.forename: Jason M
authors.initials: JM
authors.lastname: Rotoli
authors.affiliation: Department of Imaging Sciences, University of Rochester Medical Center, Rochester, NY 14642.
authors.forename: Thomas
authors.initials: T
authors.lastname: LoStracco
authors.affiliation: Department of Medicine, University of Rochester Medical Center, Rochester, NY 14642.
authors.forename: Ann R
authors.initials: AR
authors.lastname: Shamaskin
authors.affiliation: Department of Emergency Medicine, University of Rochester Medical Center, Rochester, NY 14642.
authors.forename: Joel S
authors.initials: JS
authors.lastname: Pasternack
mesh_terms: D065427:Factor Xa Inhibitors / Q000009:adverse effects* / Q000627:therapeutic use; D006801:Humans; D008297:Male; D017538:Mesenteric Artery, Superior; D065666:Mesenteric Ischemia / Q000209:etiology* / Q000601:surgery; D008875:Middle Aged; D000069552:Rivaroxaban / Q000009:adverse effects* / Q000627:therapeutic use; D013927:Thrombosis / Q000209:etiology* / Q000601:surgery; D028761:Withholding Treatment
chemical_list: D065427:Factor Xa Inhibitors; D000069552:Rivaroxaban