Pulmonary Embolism While on Therapeutic Xarelto
Joann Lohr1, Emily Wright, Medical Student2, Ranga Brahmamdam, MD2.
1Lohr Surgical Specialists, Cincinnati, OH, USA, 2Trihealth, Cincinnati, OH, USA.
OBJECTIVE- Xarelto has been hailed as a convenient and safe oral alternative for the treatment of DVT with a wide therapeutic window and lack of monitoring requirements. We describe a case of pulmonary embolism in a reliable patient who was taking Xarelto, highlighting the need for standard monitoring practices for drug efficacy and patient compliance.
METHODS- Case report and retrospective literature review of Xarelto: its uses and complcations..
RESULTS- The patient is a 57 year old female who developed a DVT after fracturing her ankle and being treated with walking boot for three weeks. She was started on BID Xarelto 15 mg therapy. Two weeks after initiating her anticoagulation regimen, the patient acutely developed chest pain and shortness of breath overnight. In the emergency room she was found to have a right lower lobe pulmonary embolism. The patient maintained that Xarelto was taken reliably no missed doses. She was admitted to the hospital for further clarification of treatment failure and was placed on IV heparin where anticoagulation was achieved. She was discharged home on Lovenox with anti Xa montoring.
CONCLUSIONS- This case demonstrates the need to reexamine the scarcity of literature surrounding dose tailoring and monitoring of Xarelto treatment. As one of a new generation of anticoagulants, Xarelto is marketed as a patient friendly and effective alternative to traditional anticoagulation regimens which require either frequent blood draws or inconvenient administration methods. The drug is currently give in fixed doses regardless of weight, and no assessment of anticoagulation success is recommended. While this allows the drug to better fit into patient schedules and improves patient satisfaction, drug failure and life threatening embolism have occurred. This calls into question both the sparse guidelines on dosing and the lack of monitoring for the purpose of efficacy and patient compliance.
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