Department of Geriatrics, 26447Peking University First Hospital, Peking University First Hospital, Beijing, China.
J Int Med Res. 2021 Sep;49(9):3000605211047712. doi: 10.1177/03000605211047712.
Although direct-acting oral anticoagulants (DOACs) decrease the bleeding risk compared with vitamin K antagonists (VKAs), DOACs might cause spontaneous hemothorax in very elderly patients, even at a very low dose. Interactions between drugs might increase the risk of bleeding. In this article, we report a case of a 95-year-old man who developed spontaneous hemothorax while taking rivaroxaban 2.5 mg twice daily, 3 days after concomitant use of itraconazole. Rivaroxaban was discontinued, and thoracentesis was performed to drain grossly bloody pleural effusion. To our knowledge, this is the first case report of spontaneous hemothorax that might have been caused by concomitant low-dose rivaroxaban and azole anti-fungal agents. This case highlights the potential risk of spontaneous hemothorax in very elderly patients while taking rivaroxaban and azole anti-fungal agents simultaneously. Special attention should be paid to interactions between drugs that might increase the risk of bleeding. Drugs that have competing metabolic pathways should be avoided. Closer monitoring, including testing for anti-Xa and additional reassessment, should be considered in high-risk patients.
虽然直接口服抗凝剂 (DOACs) 与维生素 K 拮抗剂 (VKAs) 相比，出血风险降低，但 DOACs 甚至在极低剂量下也可能导致非常高龄患者自发性血胸。药物相互作用可能会增加出血风险。在本文中，我们报告了一例 95 岁男性的病例，该患者在每日两次服用利伐沙班 2.5mg 3 天后，同时使用伊曲康唑，出现自发性血胸。停止使用利伐沙班，并进行胸腔穿刺术以排出大量血性胸腔积液。据我们所知，这是首例可能由低剂量利伐沙班和唑类抗真菌药物同时使用引起的自发性血胸的病例报告。该病例强调了非常高龄患者同时服用利伐沙班和唑类抗真菌药物时自发性血胸的潜在风险。应特别注意可能增加出血风险的药物相互作用。应避免具有竞争代谢途径的药物。在高危患者中，应考虑更密切的监测，包括检测抗 Xa 和额外的重新评估。
