University of Illinois College of Pharmacy Rockford, 1601 Parkview Avenue, Rockford, IL 61107, United States; OSF Saint Anthony Medical Center, 5666 E. State St., Rockford, IL 61108, United States.
OSF Saint Anthony Medical Center, 5666 E. State St., Rockford, IL 61108, United States.
Am J Emerg Med. 2018 Mar;36(3):531.e1-531.e2. doi: 10.1016/j.ajem.2017.12.052. Epub 2017 Dec 24.
A 66-year-old man presented to the emergency department with complaints of dark-colored stool and rash developing over the last couple of days. The patient was started on rivaroxaban and flecainide for months prior for atrial fibrillation. Upon arrival, he was awake, alert, and oriented with a blood pressure of 111/63mmHg, heart rate of 68 beats per minute, and oxygen saturation of 96% on room air. A review of systems was unremarkable with the exception of skin rash and light-headedness. The patient's initial laboratory results were significant for red blood cell (RBC) count of 4.05×10/mcL, hemoglobin of 12.1g/dL, hematocrit of 35.6%, and platelet count of 1×103/mcL. Aggressive hydration was started in the ED, initially with two 1-L boluses of normal saline followed by an infusion of 10mL/h. One unit of platelets was transfused. Rivaroxaban and flecainide were held on admission. Twenty-four hours after admission, the patient was initiated on immune globulin (IVIG) Gammagard (Baxter, West Lake, CA), 75g on 3 consecutive days and steroids for possible immune thrombocytopenia. His platelet count steadily improved over the 6-day period to 119×103/mcL on the day of hospital discharge. This is the second reported case of possible rivaroxaban-induced thrombocytopenia.
一位 66 岁男性因大便颜色发黑和皮疹在过去几天出现而到急诊科就诊。患者因心房颤动数月前开始服用利伐沙班和氟卡尼。到达时，患者意识清醒、警觉、定向正常，血压为 111/63mmHg，心率为 68 次/分钟，在室温下呼吸空气时的血氧饱和度为 96%。除皮疹和头晕外，系统回顾无明显异常。患者的初始实验室结果显著，红细胞（RBC）计数为 4.05×10/mcL，血红蛋白为 12.1g/dL，血细胞比容为 35.6%，血小板计数为 1×103/mcL。在急诊科开始积极补液，最初用两袋 1L 的生理盐水，然后以 10mL/h 的速度输注。输注了 1 单位血小板。入院时停用利伐沙班和氟卡尼。入院 24 小时后，开始给患者使用免疫球蛋白（IVIG）Gammagard（百特，加利福尼亚州西湖），连续 3 天每天 75g，并使用类固醇治疗可能的免疫性血小板减少症。他的血小板计数在 6 天内稳步上升，在出院当天达到 119×103/mcL。这是第二例可能由利伐沙班引起的血小板减少症报告病例。
