Hemorrhagic Shock from Spontaneous Splenic Rupture Requiring Open Splenectomy in a Patient Taking Rivaroxaban

Amin, Arpit; Safaya, Aditya; Ronny, Faisal M Huq; Islam, Humayun; Bhuta, Kalyani; Rajdeo, Heena

doi:10.1177/000313481608200208

Cited by 8 publications

(8 citation statements)

References 7 publications

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“…DOACs, apixaban, rivaroxaban, and dabigatran have all been associated with atraumatic splenic rupture in previous literature. 2–8 This is the third case related to apixaban. 7,8 Apixaban has anticoagulant properties by inhibiting free and bound form of factor Xa.…”

Section: Discussionmentioning

confidence: 98%

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Atraumatic splenic rupture associated with apixaban

Basnet

Mohanty

Mir

et al. 2019

SAGE Open Medical Case Reports

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Section: Discussionmentioning

confidence: 98%

“…Recently, atraumatic splenic rupture has been reported with their increasing use. 2–8 We present a case of a spontaneous splenic rupture with hemorrhagic shock requiring emergent splenic artery embolization and splenectomy in the setting of apixaban use.…”

Section: Introductionmentioning

confidence: 99%

Atraumatic splenic rupture associated with apixaban

Basnet

Mohanty

Mir

et al. 2019

SAGE Open Medical Case Reports

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“…Several authors, such as Gonzva, use the term “spontaneous splenic rupture” in the title of their article without mentioning whether they had previously looked for diseases affecting the spleen. 22 , 23 , 24 , 25 , 26 , 27 , 28 , 29 , 30 , 31 Spontaneous splenic rupture in the literature is more frequent than in real life due to language abuse. The population with a ruptured spleen associated with DOAC was much older than the all‐cause population (mean age: 72.2 vs 44 years).…”

Section: Discussionmentioning

confidence: 99%

Atraumatic splenic rupture in a patient treated with rivaroxaban: A case report and a narrative review

Labaki

Kock

2022

Clinical Case Reports

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Atraumatic splenic rupture (ASR) is a rare condition mostly associated with neoplastic, infectious, and inflammatory diseases. ASR associated with drug treatment is even rarer. In this case report, we highlight an unusual complication of the direct oral anticoagulant rivaroxaban. A 64‐year‐old male patient was admitted to the emergency department with complaints of faintness and diffuse abdominal cramps. The patient had no history of recent trauma. Clinical examination revealed hemodynamic instability with a moderate response to filling and mild abdominal discomfort on palpation. His medical history included chronic hypertension, constipation, and recent atrial flutter ablation. The patient was taking amiodarone, bisoprolol, atorvastatin, and rivaroxaban. Splenic rupture was diagnosed several hours later on contrast‐enhanced abdominal computed tomography scan. Massive blood transfusions and emergency laparotomy for splenectomy were performed. Anatomopathological analysis did not reveal any neoplastic, inflammatory, or infectious causes. The patient was successfully discharged from the intensive care unit 3 days later. Clinicians must consider the possibility of ASR as a complication of rivaroxaban in patients with abdominal tenderness and hemodynamic instability. Unfortunately, clinical presentation is not always typical of a ruptured spleen. Delayed diagnosis can be life threatening or fatal. Splenectomy via laparotomy remains the best therapeutic option in cases of splenic rupture in unstable patients on direct oral anticoagulants.

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“…Among medications, although there are cases of splenic rupture reported following granulocyte colony-stimulating factors (GCSF), anticoagulants are usually the most common offenders. Several cases of spontaneous splenic rupture have been reported with unfractionated heparin, low molecular weight heparin [3] , warfarin [4] and novel oral anticoagulants [5,6] in a previously described normal spleen. As expected, thrombolytic therapy, including both streptokinase and recombinant tissue plasminogen activator [7] , have also been implicated.…”

Section: Discussionmentioning

confidence: 99%

Atraumatic Splenic Rupture after Myocardial Infarction

Arshad

Javed

Karim

et al. 2018

European Journal of Case Reports in Internal Medicine

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Atraumatic splenic rupture is a rare but potentially life-threatening event. It mostly happens when the spleen is already diseased; however, sometimes it can be drug induced in a previously normal spleen. Although anticoagulation has been attributed to spontaneous splenic rupture quite frequently, the role of dual antiplatelet therapy is underestimated. We report a case of an 80-year-old woman who developed spontaneous splenic rupture 4 weeks after starting dual antiplatelet therapy. LEARNING POINTS• Atraumatic or spontaneous splenic rupture can be life threatening.• Various drugs, including granulocyte colony-stimulating factors (GCSF) and anticoagulants, can result in atraumatic splenic rupture in a previously normal spleen.• Dual antiplatelet therapy can also cause splenic rupture in a previously normal spleen. It can occur as early as a few weeks after initiation of treatment.

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Hemorrhagic Shock from Spontaneous Splenic Rupture Requiring Open Splenectomy in a Patient Taking Rivaroxaban

Cited by 8 publications

References 7 publications

Atraumatic splenic rupture associated with apixaban

Atraumatic splenic rupture associated with apixaban

Atraumatic splenic rupture in a patient treated with rivaroxaban: A case report and a narrative review

Atraumatic Splenic Rupture after Myocardial Infarction

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