open access

Vol 49, No 3 (2015)
Case reports
Submitted: 2015-03-23
Get Citation

Rivaroxaban 10mg/d in severe renal failure does not prevent ischemic events in premorbid neurologic disease

Claudia Stöllberger, Josef Finsterer
DOI: 10.1016/j.pjnns.2015.04.002
·
Neurol Neurochir Pol 2015;49(3):180-182.

open access

Vol 49, No 3 (2015)
Case reports
Submitted: 2015-03-23

Abstract

Backgrund

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 report

In 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.

Conclusions

In 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

Backgrund

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 report

In 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.

Conclusions

In 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.

Get Citation

Keywords

Stroke, Anticoagulation, Atrial fibrillation, Octogenarian

About this article
Title

Rivaroxaban 10mg/d in severe renal failure does not prevent ischemic events in premorbid neurologic disease

Journal

Neurologia i Neurochirurgia Polska

Issue

Vol 49, No 3 (2015)

Pages

180-182

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

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