Rivaroxaban for thromboprophylaxis in acutely Ill medical patients

摘要

to the editor: As a follow-up to the article by Cohen et al. (Feb. 7 issue)1 examining the role of oral rivaroxaban, as compared with subcutaneous enoxaparin, in the thromboprophylaxis of patients with acute medical illnesses: we report a 24-year-old man with the acute respiratory distress syndrome (ARDS) who was treated with enoxaparin (40 mg subcutaneously daily) for thromboprophylaxis. Because of worsening throm-bocytopenia, the patient was switched from enoxaparin to rivaroxaban (10 mg per day). The patient's thrombocytopenia improved, but 2 weeks after the initiation of therapy, a sudden deterioration in alertness and mental status was noted. Urgent computed tomography of the brain revealed bilateral occipital bleeding, and rivaroxaban was subsequently discontinued (Fig. 1).