EC Pulmonology and Respiratory Medicine

Case Report Volume 12 Issue 5 - 2023

Asymptomatic Intracerebral Hemorrhage Under Rivaroxaban

Ekkehard Pietsch*

Department of Trauma and Orthopaedics, The Expert, Germany

*Corresponding Author: Ekkehard Pietsch, Department of Trauma and Orthopaedics, The Expert, Germany.
Received: May 27, 2023; Published:June 19, 2023

Bleeding is one of the side effects of oral anticoagulants. They need to be taken into account with a frequency of less than 1% per treatment year. They can evolve from an asymptomatic onset to a potentially life-threatening complication. In two patients, an intracerebral hemorrhage was incidentally detected before it could manifest clinically. This suggests that the actual number of anticoagulant-related complications may be higher than reported.

Keywords: Intracerebral Hemorrhage; Rivaroxaban; Apixaban

  1. Qureshi AI., et al. “Intracerebral haemorrhage”. Lancet 373 (2009): 1632-1644.
  2. Kleindorfer D., et al. “The unchanging incidence and case-fatality of stroke in the 1990s: a population-based study”. Stroke A Journal of Cerebral Circulation 37 (2006): 2473-2478.
  3. Hart RG., et al. “Oral anticoagulants and intracranial hemorrhage. Facts and hypotheses”. Stroke 26 (1995): 1471-1477.
  4. Patel MR., et al. “Rivaroxaban versus warfarin in nonvalvular atrial fibrillation”. The New England Journal of Medicine 365 (2011): 883-891.
  5. Alberts MJ., et al. “Antithrombotic therapy for stroke prevention in non-valvular atrial fibrillation”. Lancet Neurology 11 (2012): 1066-1081.
  6. EINSTEIN Investigators Bauersachs R., et al. “Oral rivaroxaban for symptomatic venous thromboembolism”. The New England Journal of Medicine 363 (2010): 2499-2510.
  7. Ingason AB., et al. “Rivaroxaban Is Associated with Higher Rates of Gastrointestinal Bleeding Than Other Direct Oral Anticoagulants: A Nationwide Propensity Score-Weighted Study”. Annals of Internal Medicine 11 (2021): 1493-1502.
  8. Graff J and Harder S. “Anticoagulant Therapy with the Oral Direct Factor Xa Inhibitors Rivaroxaban, Apixaban and Edoxaban and the Thrombin Inhibitor Dabigatran Etexilate in Patients with Hepatic Impairment”. Clinical Pharmacokinetics 52 (2013): 243-254.
  9. Kubitza D., et al. “Effects of renal impairment on the pharmacokinetics, pharmacodynamics and safety of rivaroxaban, an oral, direct Factor Xa inhibitor”. British Journal of Clinical Pharmacology 70 (2010): 703-712.
  10. Samama MM. “Use of low-molecular-weight heparins and new anticoagulants in elderly patients with renal impairment”. Drugs Aging 28 (2011): 177-193.
  11. Hori M., et al. “Safety and efficacy of adjusted dose of rivaroxaban in Japanese patients with non-valvular atrial fibrillation-subanalysis of J-ROCKET AF for patients with moderate renal impairment”. Circulation Journal 77 (2013): 632-638.
  12. Ruff CT., et al. “Association between edoxaban dose, concentration, anti- Factor Xa activity, and outcomes: an analysis of data from the randomised, double-blind ENGAGE AF-TIMI 48 trial”. Lancet 9984 (2015): 2288-2295.
  13. Nagaraja V., et al. “Spontaneous splenic rupture due to rivaroxaban”. BMJ Case Reports (2018): 1-3.
  14. Amin A., et al. “Hemorrhagic Shock from Spontaneous Splenic Rupture Requiring Open Splenectomy in a Patient Taking Rivaroxaban”. The American Surgeon (2021).
  15. Hellwig T and Gulseth M. “Pharmacokinetic and pharmacodynamic drug interactions with new oral anticoagulants: what do they mean for patients with atrial fibrillation?” Annals of Pharmacotherapy 47 (2013): 1478-1487.
  16. Gonzva J., et al. “Spontaneus splenic rupture in a patient treated with rivaroxaban”. American Journal of Emergency Medicine 32 (2014): 950.
  17. Hart RG., et al. “Antithrombotic therapy to prevent stroke in patients with atrial fibrillation: a meta-analysis”. Annals of Internal Medicine 131 (1999): 492-501.
  18. Flaherty ML., et al. “The increasing incidence of anticoagulant-associated intracerebral hemorrhage”. Neurology 68 (2007): 116-121.
  19. Krishnamurthi RV., et al. “Global and regional burden of first-ever ischaemic and haemorrhagic stroke during 1990-2010: findings from the Global Burden of Disease Study 2010”. The Lancet Global Health 1 (2013): e259-e281.
  20. Angelozzi A., et al. “The Risk of Intracranial Hemorrhage with Anticoagulation in the Elderly - Estimates of Prevalence and Therapeutic Strategies”. American college of Cardiology (2015).
  21. Lo JC and Gerona RR. “Rivaroxaban Associated Intracranial Hemorrhage”. Western Journal of Emergency Medicine 4 (2014).
  22. Ruschel LG., et al. “Spontaneous intracranial epidural hematoma during rivaroxaban treatment”. Revista da Associação Médica Brasileira 8 (1992): 721-724.
  23. Ruschel LG., et al. “Spontaneous intracranial epidural hematoma during rivaroxaban treatment”. Revista da Associação Médica Brasileira 8 (1992): 721-724.
  24. Chen X., et al. “Bleeding risks with novel oral anticoagulants especially rivaroxaban versus aspirin: a meta- analysis”. Thrombosis Journal 19 (2021): 69.

Ekkehard Pietsch. "Asymptomatic Intracerebral Hemorrhage Under Rivaroxaban". EC Pulmonology and Respiratory Medicine  12.5 (2023): 54-59.