Cor Vasa 2019, 61(4):e436-e438 | DOI: 10.1016/j.crvasa.2018.09.002

Direct-acting oral anticoagulants: Less is not always more

Kamran Majeed^a, Adam J. Nelson^a,b,c, Peter J. Psaltis^a,b,c, Matthew I. Worthley^a,b,c

^a Department of Cardiology, Royal Adelaide Hospital, Adelaide, Australia

^b Discipline of Medicine, University of Adelaide, Adelaide, Australia

^c South Australian Health and Medical Research Institute, Adelaide, Australia

We report a case in which self-prescribed dose reduction of the orally active, direct factor Xa inhibitor, rivaroxaban, was associated with the unusual thrombo-embolic complication of acute ST-segment elevation myocardial infarction (STEMI) in the setting of a fluctuating renal function and estimated glomerular filtration falling in and out of the range where dose reduction of rivaroxaban is suggested. The case highlights the importance of dosing of rivaroxaban in those patients who sit around the recommended dosage regimen cut offs as they are well known to be at risk of bleeding should their CrCl fall

Keywords: Direct-acting oral anticoagulants, ST-segment elevation MI, Thrombo-embolism

Received: August 21, 2018; Accepted: September 15, 2018; Published: August 11, 2019  Show citation