Gastrointestinal bleeding induced by rivaroxaban combined with dronedarone
10.3760/cma.j.cn114015-20220801-00702
- VernacularTitle:利伐沙班与决奈达隆联用致消化道出血
- Author:
Ziran NIU
1
;
Yihong SUN
;
He LUO
;
Min MAO
Author Information
1. 中国医学科学院北京协和医学院北京协和医院药剂科，北京 100730
- Publication Type:Journal Article
- Keywords:
Rivaroxaban;
Dronedarone;
Gastrointestinal bleeding;
Drug Interaction;
Cytochrome P-450
- From:
Adverse Drug Reactions Journal
2023;25(8):511-512
- CountryChina
- Language:Chinese
-
Abstract:
A 78-year-old female patient with atrial fibrillation developed tarry stools after regularly taking dronedarone, metoprolol, and rivaroxaban for 3 months. The patient stopped using rivaroxaban by herself for 7 days, and her black stools was gradually improved. After taking rivaroxaban again for 1 month, black stools appeared again, accompanied by fatigue, dizziness, and amaurosis fugax. Her blood pressure was 90/50 mmHg, heart rate was 80 beats/min, and hemoglobin was 55 g/L. Rivaroxaban was discontinued again and supportive treatments such as soft food, acid suppression, fluid replacement, and blood transfusion were given. After 3 days of treatments, the symptoms of fatigue were improved significantly, and no amaurosis recurred when sitting up. Hemoglobin was 75 g/L. After 6 days of treatments, the patient discharged formed yellow soft stools. After excluding gastrointestinal tumors through gastroscopy and tumor marker examination, it was considered that the interaction of dronedarone and rivaroxaban caused the increase of rivaroxaban plasma concentration, which resulted in gastrointestinal bleeding in the patient. The patient′s anticoagulant medication was changed to dabigatran etexilate, and no gastrointestinal bleeding occurred.
