Department of Vascular Surgery, Amsterdam UMC, location VU Medical Centre, the Netherlands.
Vasc Endovascular Surg. 2021 Oct;55(7):749-751. doi: 10.1177/15385744211004763. Epub 2021 Mar 25.
Anticoagulant therapy is indicated for the prevention and treatment of thromboembolic disease. Direct oral anticoagulants (DOACs) are frequently prescribed and Rivaroxaban is the most frequently administered DOAC in the Netherlands. Most side effects relate to hemorrhagic complications, however, also non-hemorrhagic side effect may be potentially life threatening.
A 74-year-old man presented at the emergency department with a ruptured infrarenal abdominal aortic aneurysm for which open aneurysm repair was performed. Postoperatively, the patient developed neurological deficit, respiratory and circulatory failure following rivaroxaban administration, initiated for atrial fibrillation. Even though, the clinical signs resembled an anaphylactic reaction, the skin-prick test was negative and complications most likely resulted from a non-allergic drug hypersensitivity reaction.
This case report shows that non-allergic drug hypersensitivity reactions may mimic an anaphylactic reaction and can be potentially life threatening. In addition, severe non-hemorrhagic complications after rivaroxaban administration do occur and should be considered in case of acute clinical deterioration.
抗凝治疗用于预防和治疗血栓栓塞性疾病。直接口服抗凝剂（DOACs）经常被开处方，利伐沙班是荷兰最常使用的 DOAC。大多数副作用与出血并发症有关，但非出血性副作用也可能危及生命。
一名 74 岁男性因破裂的肾下腹部主动脉瘤就诊于急诊，行开放动脉瘤修复术。术后，该患者在开始使用利伐沙班治疗心房颤动后出现神经功能缺损、呼吸和循环衰竭。尽管临床症状类似于过敏反应，但皮肤点刺试验为阴性，并发症很可能是由非过敏性药物过敏反应引起的。
本病例报告表明，非过敏性药物过敏反应可能类似于过敏反应，并且可能危及生命。此外，利伐沙班治疗后确实会发生严重的非出血性并发症，在出现急性临床恶化时应考虑这些并发症。
