Li Xiaolong, Xu Shuhao, Zeng Chunfang, Han Ding, Wang Xin
Pulmonary and Critical Care Medicine, Deyang People's Hospital, Deyang, China.
Department of Stomatology, Deyang People's Hospital, Deyang, China.
Front Med (Lausanne). 2025 Jul 29;12:1641092. doi: 10.3389/fmed.2025.1641092. eCollection 2025.
Rivaroxaban, a novel oral anticoagulant, is widely used in patients with non-valvular atrial fibrillation. Bleeding events during rivaroxaban therapy most commonly include gastrointestinal bleeding and intracranial hemorrhage, while spontaneous hemothorax is exceedingly rare. We report a case of spontaneous hemothorax occurring during rivaroxaban administration.
We report the case of a patient presenting primarily with dyspnea. The patient had been on long-term oral rivaroxaban for atrial fibrillation. Physical examination upon admission revealed diminished breath sounds in the left lung. Computed tomography imaging demonstrated a large left-sided pleural effusion with adjacent pulmonary atelectasis. Laboratory tests indicated significant coagulation abnormalities. After admission, the patient underwent therapeutic thoracentesis and chest tube placement, with bloody pleural fluid observed in the drainage. Due to the marked coagulation abnormalities on admission, the patient received fresh frozen plasma transfusion. Further history-taking revealed recent use of oral fluconazole. A review of the literature suggested that the spontaneous hemothorax might be associated with the concurrent use of rivaroxaban and fluconazole.
Following treatment, a follow-up computed tomography scan 3 months later showed no evidence of recurrent hemothorax.
Concomitant administration of rivaroxaban and fluconazole significantly increases the risk of bleeding events, necessitating clinician vigilance regarding potential drug-drug interactions when formulating therapeutic regimens.
利伐沙班是一种新型口服抗凝剂，广泛应用于非瓣膜性心房颤动患者。利伐沙班治疗期间的出血事件最常见的包括胃肠道出血和颅内出血，而自发性血胸极为罕见。我们报告一例在服用利伐沙班期间发生自发性血胸的病例。
我们报告一例主要表现为呼吸困难的患者。该患者长期口服利伐沙班治疗心房颤动。入院时体格检查发现左肺呼吸音减弱。计算机断层扫描成像显示左侧大量胸腔积液伴相邻肺不张。实验室检查表明存在明显的凝血异常。入院后，患者接受了治疗性胸腔穿刺和胸腔闭式引流管置入，引流液中观察到血性胸腔积液。由于入院时存在明显的凝血异常，患者接受了新鲜冰冻血浆输注。进一步询问病史发现患者近期使用过口服氟康唑。文献回顾提示自发性血胸可能与利伐沙班和氟康唑的同时使用有关。
治疗后，3个月后的随访计算机断层扫描显示无复发性血胸迹象。
利伐沙班和氟康唑同时使用显著增加出血事件风险，临床医生在制定治疗方案时必须警惕潜在的药物相互作用。
