Rudd Kelly M, Panneerselvam Narmadha, Patel Anush
Department of Pharmaceutical Care, Pharmacology, and Pharmacotherapy, Section of Clinical Pharmacy, Bassett Medical Center, Cooperstown, NY
Department of Medicine, Monmouth Medical Center, Long Branch, NJ.
Am J Health Syst Pharm. 2018 Mar 15;75(6):347-349. doi: 10.2146/ajhp160985. Epub 2018 Jan 18.
A case of a patient who developed a hypersensitivity reaction to rivaroxaban in the form of a diffuse, exanthematous rash is reported.
After starting rivaroxaban for treatment of cancer-associated deep vein thrombosis (DVT) with pulmonary embolism (PE), a 69-year-old Caucasian woman arrived at an oncology clinic with a diffuse, exanthematous (morbilliform) rash on her neck and torso, spreading to her upper and lower extremities. She reported that the symptoms started to develop about 48 hours after transitioning from subcutaneous enoxaparin to oral rivaroxaban. The patient's symptoms did not subside with diphenhydramine 25-50 mg orally every 6-8 hours. The patient was switched back to enoxaparin therapy for continued anticoagulation therapy. On day 5, rivaroxaban and diphenhydramine were discontinued. Oral dexamethasone 4 mg twice daily was initiated, and the patient transitioned from rivaroxaban to enoxaparin 1 mg/kg every 12 hours subcutaneously. On day 8, the rash had diminished considerably and was present only on her thighs. Analysis of the case using the adverse drug reaction probability scale of Naranjo et al. indicated that rivaroxaban was the probable cause of the hypersensitivity reaction. Four prior case reports of rivaroxaban hypersensitivity manifesting as a rash have been previously reported, with this being the first in a female and the first in a patient undergoing treatment of DVT and PE in the setting of active cancer.
A 69-year-old Caucasian woman developed a diffuse, exanthematous rash on day 3 of rivaroxaban treatment. Symptoms abated after rivaroxaban discontinuation and treatment with dexamethasone.
报告一例对利伐沙班发生超敏反应，表现为弥漫性疹性皮疹的患者。
一名69岁的白人女性在开始使用利伐沙班治疗伴有肺栓塞（PE）的癌症相关深静脉血栓形成（DVT）后，前往肿瘤诊所，其颈部和躯干出现弥漫性疹性（麻疹样）皮疹，并蔓延至上下肢。她报告称，从皮下注射依诺肝素转换为口服利伐沙班后约48小时开始出现症状。患者每6 - 8小时口服25 - 50毫克苯海拉明后症状未消退。患者转回依诺肝素治疗以继续抗凝治疗。第5天，停用利伐沙班和苯海拉明。开始每日两次口服4毫克地塞米松，患者从利伐沙班转换为每12小时皮下注射1毫克/千克依诺肝素。第8天，皮疹明显减轻，仅大腿部位仍有。使用Naranjo等人的药物不良反应概率量表对该病例进行分析表明，利伐沙班可能是超敏反应的原因。此前已有4例利伐沙班超敏反应表现为皮疹的病例报告，此为首例发生在女性患者以及首例在活动性癌症背景下接受DVT和PE治疗的患者中。
一名69岁的白人女性在利伐沙班治疗第3天出现弥漫性疹性皮疹。停用利伐沙班并用地塞米松治疗后症状缓解。
