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Clinics and Practice
Volume 6
Issue 3
10.4081/cp.2016.873
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Clinics and Practice is published by MDPI from Volume 11 Issue 1 (2021). Previous articles were published by another publisher in Open Access under a CC-BY (or CC-BY-NC-ND) licence, and they are hosted by MDPI on mdpi.com as a courtesy and upon agreement with PAGEPress.
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Case Report

Medication Error When Switching from Warfarin to Rivaroxaban Leading to Spontaneous Large Ecchymosis of the Abdominal and Chest Wall

by
Flavio Egger
1,
Federica Targa
2,
Ivan Unterholzner
1,
Russell P. Grant
3,
Markus Herrmann
2 and
Christian J. Wiedermann
1,*
1
Department of Internal Medicine, Central Hospital of Bolzano, Lorenz-Böhler-Street 5, 39100 Bolzano (BZ), Italy
2
Department of Clinical Pathology, Central Hospital of Bolzano, Lorenz-Böhler-Street 5, 39100 Bolzano (BZ), Italy
3
Center for Esoteric Testing, Laboratory Corporation of America® Holdings, Burlington, NC 27215, USA
*
Author to whom correspondence should be addressed.
Clin. Pract. 2016, 6(3), 873; https://doi.org/10.4081/cp.2016.873
Submission received: 19 July 2016 / Revised: 19 July 2016 / Accepted: 10 August 2016 / Published: 11 August 2016

Abstract

Non-vitamin K oral anticoagulant (NOAC) therapy may be inappropriate if prescription was incorrect, the patient’s physiological parameters change, or interacting concomitant medications are erroneously added. The aim of this report was to illustrate inappropriate NOAC prescription in a 78-year-old woman with non-valvular atrial fibrillation and borderline renal dysfunction who was switched from warfarin to rivaroxaban and subsequently developed bruising with hemorrhagic shock and acute on chronic renal failure. Administration of 4-factor prothrombin complex concentrate effectively reversed coagulopathy and stopped bleeding. Retrospective determination of circulating plasma levels of rivaroxaban and warfarin confirmed that excessive anticoagulation was likely due to warfarin that the patient probably continued to take although rivaroxaban was initiated. Pharmacodynamic interaction between rivaroxaban and warfarin may not only be additive but synergistic. In patients at high risk of complications, judicious prescribing and dosing of NOACs, and regular monitoring of concomitant medications and renal function are highly recommended.
Keywords: direct oral anticoagulants; therapeutic drug monitoring; drug safety; drug-drug interaction; pharmacovigilance; anticoagulant reversal; prothrombin complex concentrate direct oral anticoagulants; therapeutic drug monitoring; drug safety; drug-drug interaction; pharmacovigilance; anticoagulant reversal; prothrombin complex concentrate

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MDPI and ACS Style

Egger, F.; Targa, F.; Unterholzner, I.; Grant, R.P.; Herrmann, M.; Wiedermann, C.J. Medication Error When Switching from Warfarin to Rivaroxaban Leading to Spontaneous Large Ecchymosis of the Abdominal and Chest Wall. Clin. Pract. 2016, 6, 873. https://doi.org/10.4081/cp.2016.873

AMA Style

Egger F, Targa F, Unterholzner I, Grant RP, Herrmann M, Wiedermann CJ. Medication Error When Switching from Warfarin to Rivaroxaban Leading to Spontaneous Large Ecchymosis of the Abdominal and Chest Wall. Clinics and Practice. 2016; 6(3):873. https://doi.org/10.4081/cp.2016.873

Chicago/Turabian Style

Egger, Flavio, Federica Targa, Ivan Unterholzner, Russell P. Grant, Markus Herrmann, and Christian J. Wiedermann. 2016. "Medication Error When Switching from Warfarin to Rivaroxaban Leading to Spontaneous Large Ecchymosis of the Abdominal and Chest Wall" Clinics and Practice 6, no. 3: 873. https://doi.org/10.4081/cp.2016.873

APA Style

Egger, F., Targa, F., Unterholzner, I., Grant, R. P., Herrmann, M., & Wiedermann, C. J. (2016). Medication Error When Switching from Warfarin to Rivaroxaban Leading to Spontaneous Large Ecchymosis of the Abdominal and Chest Wall. Clinics and Practice, 6(3), 873. https://doi.org/10.4081/cp.2016.873

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