title: Acute Liver Failure after Initiation of Rivaroxaban: A Case Report and Review of the Literature.
abstract: BACKGROUND
  Rivaroxaban is a direct factor Xa inhibitor approved for the prevention of thromboembolism. Drug induced liver injury has been increasingly reported with rivaroxaban recently, but actual liver failure has not been reported.
  
  
  METHODS
  We present a case report on the probable occurrence of acute liver failure with rivaroxaban therapy. An 89 year old woman with history of atrial fibrillation was hospitalized for biventricular congestive heart failure with passive congestion of liver, which responded to furosemide. She was discharged home on rivaroxaban for prevention of thrombo-embolism. Liver function tests upon discharge returned to almost normal range. One week later, she presented with abdominal pain and was found to have highly elevated liver enzymes, elevated bilirubin, and an abnormal coagulation profile. A day later, she developed hepatic encephalopathy, suggesting liver failure.
  
  
  CONCLUSIONS
  Liver enzymes declined rapidly with the discontinuation of all of her medications, however patient died because of multi-organ failure. The causality assessment in this patient was "probable" with rivaroxaban.
authors.affiliation: Department of Internal Medicine, UAB Health Center Montgomery, Montgomery, Alabama, USA.
authors.forename: Muhammad
authors.initials: M
authors.lastname: Baig
authors.affiliation: Department of Internal Medicine, UAB Health Center Montgomery, Montgomery, Alabama, USA.
authors.forename: Kenneth J
authors.initials: KJ
authors.lastname: Wool
authors.affiliation: Department of Internal Medicine, UAB Health Center Montgomery, Montgomery, Alabama, USA.
authors.forename: Jewell H
authors.initials: JH
authors.lastname: Halanych
authors.affiliation: Department of Internal Medicine, UAB Health Center Montgomery, Montgomery, Alabama, USA.
authors.forename: Rehan A
authors.initials: RA
authors.lastname: Sarmad
keywords: Drug toxicity; liver failure; rivaroxaban