首页> 外文期刊>Journal of Medical Case Reports >Acute-onset severe gastrointestinal tract hemorrhage in a postoperative patient taking rivaroxaban after total hip arthroplasty: a case report
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Acute-onset severe gastrointestinal tract hemorrhage in a postoperative patient taking rivaroxaban after total hip arthroplasty: a case report

机译:全髋关节置换术后服用利伐沙班的术后急性发作严重胃肠道出血:一例报告

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Introduction Rivaroxaban, a new oral anticoagulant, is currently licensed for use in patients undergoing orthopedic surgery. It is more efficacious than other anticoagulants such as low molecular weight heparin and does not require daily monitoring. It has also been shown to be efficacious in patients with venous thromboembolism and acute coronary syndrome. Although hemorrhage is a known side effect of this new anticoagulant, we could find no case reports in the literature of patients suffering severe hemorrhage whilst taking rivaroxaban. Thus, we describe the first case of potentially fatal hemorrhage in a patient taking rivaroxaban. Case presentation We report the case of a 58-year-old Caucasian man with acute-onset severe per rectal bleeding who had undergone total hip arthroplasty four weeks prior to the onset of symptoms and was taking rivaroxaban in the postoperative period. Rivaroxaban was discontinued immediately but, having required nine units of packed red blood cells in a peripheral hospital due to a rapidly decreasing hemoglobin level, our patient was transferred to our tertiary referral center where he required a further eight units of packed red blood cells over a 48-hour period to manage his ongoing hemorrhage and maintain hemodynamic stability. No source of bleeding was found on computed tomography angiography and our patient’s condition improved over the following 48?hours with cessation of the hemorrhage. Our patient was discharged home well several days later. A follow-up colonoscopy one week after his discharge was normal. Conclusion Although advantageous with regard to its oral availability and ongoing use without the need for daily monitoring, rivaroxaban does not come without rare but severe side effects. When severe per rectal bleeding occurs in a patient taking rivaroxaban, discontinuation of the offending agent and aggressive hematological replacement are the mainstays of treatment, especially when no source of bleeding can be found. This case, as the first to describe severe hemorrhage and rivaroxaban, serves as a reminder to those prescribing the medicine that they must inform the patient of the risk of such a serious side effect and the need for urgent medical attention if it occurs.
机译:简介利伐沙班是一种新型口服抗凝剂,目前已获准用于进行骨科手术的患者。它比其他抗凝剂(例如低分子量肝素)更有效,并且不需要每日监测。也已显示它对静脉血栓栓塞和急性冠状动脉综合征有效。尽管出血是这种新型抗凝剂的已知副作用,但在文献中我们没有发现在服用利伐沙班时遭受严重出血的患者的病例报告。因此,我们描述了服用利伐沙班的患者中首例可能致命的出血。病例介绍我们报告了一名58岁高加索人的病例,该人患有急性直肠严重出血,在症状发作前四周接受了全髋关节置换术,术后接受利伐沙班治疗。利伐沙班立即停药,但由于血红蛋白水平迅速下降,在外围医院中需要9个单位的红细胞充血,我们的患者被转移到我们的三级转诊中心,在那里他还需要另外8个单位的红细胞充血。在48小时内管理其持续的出血并维持血液动力学稳定。在计算机断层血管造影术中未发现出血源,并且在停止出血后的48小时内,我们患者的病情有所改善。几天后我们的病人出院了。他出院一周后的结肠镜检查正常。结论尽管利伐沙班在口服有效度和持续使用方面无须每日监测,但利伐沙班并非没有罕见但严重的副作用。当服用利伐沙班的患者发生严重的直肠直肠出血时,中断治疗药物和积极的血液学替代治疗是治疗的主要手段,尤其是在找不到出血源的情况下。该病例是第一个描述严重出血和利伐沙班的病例,这提醒了那些开药处方的人,他们必须告知患者这种严重副作用的风险,并在发生这种情况时需要紧急医疗护理。

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