Spontaneous splenic rupture due to rivaroxaban

Abstract

In conjunction with BMJ Case Reports, DTB will feature occasional drug-related cases that are likely to be of interest to readers. These will include cases that involve recently marketed drugs for which there is limited knowledge of adverse effects and cases that highlight unusual reactions to drugs that have been marketed for several years.

Atraumatic splenic rupture associated with apixaban

“…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.…”

“…15 PCC, FFP, and recombinant activated factor VII can be used in this setting despite lack of evidence. 3 Current guidelines recommend RBC transfusion, platelet, and cryoprecipitate transfusion to maintain target hemoglobin >7 g/dL, platelet count >50,000/µL, and fibrinogen >100 mg/dL, respectively. 15 With andexanet alfa being approved by FDA for reversal of anticoagulation in life-threatening or uncontrolled bleeding, 16 it will be interesting to know its efficacy in patients with splenic hemorrhage.…”

“…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.…”