A Case of Symptomatic Supratherapeutic International Normalized Ratio on Rivaroxaban.
direct oral anti-coagulants
high inr
international normalized ratio
rivaroxaban
supra-therapeutic inr
Journal
Cureus
ISSN: 2168-8184
Titre abrégé: Cureus
Pays: United States
ID NLM: 101596737
Informations de publication
Date de publication:
Jun 2023
Jun 2023
Historique:
accepted:
11
06
2023
medline:
14
6
2023
pubmed:
14
6
2023
entrez:
14
6
2023
Statut:
epublish
Résumé
Rivaroxaban is a direct oral anticoagulant that works by inhibiting factor Xa. Direct anticoagulants have largely replaced direct vitamin K inhibitors (VKAs) due to the decreased risk of major hemorrhages and the lack of need for regular monitoring and dose adjustments. However, there have been multiple reports of elevated international normalized ratio (INR) and bleeding incidents in patients on rivaroxaban, which brings into question the potential need for monitoring. We report a case of an INR of 4.8 in a rivaroxaban-naïve patient who presented with gastrointestinal bleeding and a significant drop in hemoglobin four days after starting rivaroxaban. We present possible pharmacologic explanations. We propose the idea that specific subgroups of patients may be at risk for true INR elevations and may benefit from routine monitoring of their INR while on rivaroxaban.
Identifiants
pubmed: 37313284
doi: 10.7759/cureus.40282
pmc: PMC10259092
doi:
Types de publication
Case Reports
Langues
eng
Pagination
e40282Informations de copyright
Copyright © 2023, Khidhir et al.
Déclaration de conflit d'intérêts
The authors have declared that no competing interests exist.
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