Sasson Evan, James Marian, Russell Mark, Todorov Darko, Cohen Henry
1 Department of Pharmacy, Kingsbrook Jewish Medical Center, Brooklyn, New York, NY, USA.
2 Department of Medicine, Kingsbrook Jewish Medical Center, Brooklyn, New York, NY, USA.
J Pharm Pract. 2018 Oct;31(5):503-506. doi: 10.1177/0897190017722872. Epub 2017 Aug 14.
Rivaroxaban is a novel oral anticoagulant with several indications, one of which is for stroke prevention in nonvalvular atrial fibrillation. We present a case of probable rivaroxaban-induced rash.
A 79-year-old female with a medical history of atrial fibrillation experienced a stroke, after which she was prescribed rivaroxaban 20 mg. After several days, she developed a rash requiring admission to the emergency department and several days of treatment. The rash resolved and she was switched from rivaroxaban to apixaban and did not experience any adverse drug events.
Onset of symptoms occurred within days of rivaroxaban initiation. The patient had no allergy history and never reported a similar reaction while on concurrent home medication regimen. The resolution of rash and toleration of apixaban suggest a rivaroxaban-specific reaction. The mechanism of this rash is currently unclear.
We report one of the first cases of probable rivaroxaban-induced rash, whereas the patient tolerated apixaban. Further investigation is warranted, but prescribers should be cognizant of this potential issue when choosing a factor Xa inhibitor for anticoagulation.
利伐沙班是一种新型口服抗凝剂，有多种适应证，其中之一是用于非瓣膜性心房颤动的卒中预防。我们报告一例可能由利伐沙班引起的皮疹病例。
一名79岁有房颤病史的女性发生了卒中，之后她被处方了20mg利伐沙班。几天后，她出现了皮疹，需要入住急诊科并接受了几天治疗。皮疹消退后，她从利伐沙班换用了阿哌沙班，且未发生任何药物不良事件。
症状在开始使用利伐沙班数天内出现。该患者无过敏史，在家中同时服用其他药物时也从未报告过类似反应。皮疹消退以及对阿哌沙班的耐受性表明这是一种利伐沙班特异性反应。这种皮疹的机制目前尚不清楚。
我们报告了首例可能由利伐沙班引起的皮疹病例，而该患者对阿哌沙班耐受。有必要进行进一步研究，但在选择Xa因子抑制剂进行抗凝治疗时，处方者应认识到这一潜在问题。
