Tuberc Respir Dis.  2014 Mar;76(3):127-130.

Effect of Rivaroxaban on Fibrinolytic Therapy in Massive Pulmonary Embolism: Two Cases

• Kim HJ
• Koo SM
• Ham NS
• Kim KU
• Uh ST
• Kim YK

Abstract

The risk of dying from a pulmonary embolism (PE) is estimated to be about 30% if inotropic support is required and no cardiopulmonary arrest occurs. Fibrinolysis in massive PE is regarded as a life-saving intervention, unless there is a high risk of bleeding following the use of the fibrinolytic therapy. Rivaroxaban is an oral factor Xa inhibitor, however its anticoagulation effects before or after administration of fibrinolytics in massive PE are still unknown. Two patents were admitted: 61-year-old woman with repeated syncope, and a 73-year-old woman was admitted with dyspnea and poor oral intake. Systemic arterial hypotension with radiologic confirmation led to a diagnosis of massive PE in both patients. Rivaroxaban was administered before in one, and after firbrinolytic therapy in the other. One showed similar efficacy of rivaroxaban with currently used anticoagulants after successful fibrinolysis, and the other one without antecedent administration of the fibrinolytic agent showed unfavorable efficacy of rivaroxaban.

Keyword

Pulmonary Embolism; Rivaroxaban; Fibrinolysis

MeSH Terms

Aged
Anticoagulants
Diagnosis
Dyspnea
Factor Xa
Female
Fibrinolysis
Heart Arrest
Hemorrhage
Humans
Hypotension
Middle Aged
Pulmonary Embolism*
Syncope
Thrombolytic Therapy*
Rivaroxaban
Anticoagulants
Factor Xa

Figure

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  Figure 1 Computed tomographic pulmonary angiogram showed extensive bilateral acute pulmonary embolism and enlarged right cardiac chambers (case no. 1).

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  Figure 2 Computed tomographic pulmonary angiogram showed massive bilateral pulmonary embolism with lung infarction before (A, B) and after (C, D) administration of fibrinolytics (case no. 2).

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  Figure 3 Flow chart on treatment methods, hemodynamic parameters, and location of management. ICU: intensive care unit; HAD: hospital admission day; UFH: unfractionated heparin; LMWH: low molecular weight heparin; tPA: tissue plasminogen activator; RVE: right ventricular enlargement; RV, right ventricular; TR max: maximum velocity of tricuspid regurgitation; NT-pro-BNP: N terminal pro-natriuretic peptide.

Reference

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