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Rivaroxaban 10mg/d in severe renal failure does not prevent ischemic events in premorbid neurologic disease
Affiliations- Krankenanstalt Rudolfstiftung, Juchgasse 25, A-1030 Wien, Austria
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Abstract
The direct oral anticoagulants (DOAC) are increasingly used for primary and secondary stroke prophylaxis in atrial fibrillation, although their use in patients with renal failure is problematic.
Case reportIn an 82-years old female with recurrent strokes and atrial fibrillation, the vitamin-K-antagonist was changed to rivaroxaban because of “unstable international normalized ratio (INR) values”. Because of renal failure with a creatinine clearance of 32ml/min, a dosage of rivaroxaban 10mg/d was chosen. Eleven days after initiation of rivaroxaban, she was re-hospitalized because of acute onset of right-sided weakness of the upper and lower limbs.
ConclusionsIn cases of stroke, renal failure and inadequate anticoagulation it is not useful to change from vitamin-K-antagonists to “low dose” DOAC. Diligent investigations for the cause of INR-instability and continuation of vitamin-K-antagonist therapy seem to be more effective and safer since there is the opportunity of monitoring therapy and to avoid under- as well as over-dosage.
Abstract
The direct oral anticoagulants (DOAC) are increasingly used for primary and secondary stroke prophylaxis in atrial fibrillation, although their use in patients with renal failure is problematic.
Case reportIn an 82-years old female with recurrent strokes and atrial fibrillation, the vitamin-K-antagonist was changed to rivaroxaban because of “unstable international normalized ratio (INR) values”. Because of renal failure with a creatinine clearance of 32ml/min, a dosage of rivaroxaban 10mg/d was chosen. Eleven days after initiation of rivaroxaban, she was re-hospitalized because of acute onset of right-sided weakness of the upper and lower limbs.
ConclusionsIn cases of stroke, renal failure and inadequate anticoagulation it is not useful to change from vitamin-K-antagonists to “low dose” DOAC. Diligent investigations for the cause of INR-instability and continuation of vitamin-K-antagonist therapy seem to be more effective and safer since there is the opportunity of monitoring therapy and to avoid under- as well as over-dosage.
Keywords
Stroke, Anticoagulation, Atrial fibrillation, Octogenarian
About this articleTitle
Rivaroxaban 10mg/d in severe renal failure does not prevent ischemic events in premorbid neurologic disease
Journal
Neurologia i Neurochirurgia Polska
Issue
Pages
180-182
Page views
217
Article views/downloads
301
DOI
10.1016/j.pjnns.2015.04.002
Bibliographic record
Neurol Neurochir Pol 2015;49(3):180-182.
Keywords
Stroke
Anticoagulation
Atrial fibrillation
Octogenarian
Authors
Claudia Stöllberger
Josef Finsterer
