Research and practice in thrombosis and haemostasis · 2025
Rivaroxaban use during vitamin K1 therapy for rodenticide poisoning.
Клинический случайСтатьяНазвание и аннотация: Перевод в очереди
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Escal Jean, Drague Angélique, Poenou Géraldine, Noyel Pauline, Bertoletti Laurent, Tardy Brigitte, Delavenne Xavier
Аннотация
BACKGROUND: Management of severe anticoagulant rodenticide poisoning relies mainly on vitamin K1 (VK1) therapy, which often requires prolonged administration when long-acting anticoagulant rodenticides (LAARs) are involved.
KEY CLINICAL QUESTION: Can a direct oral anticoagulant (DOAC) be safely reintroduced in a patient at high risk of thrombosis recurrence whose LAAR poisoning is being managed with prolonged VK1 therapy?
CLINICAL APPROACH: We report the case of a patient receiving rivaroxaban for recurrent thrombosis who ingested massive amounts of brodifacoum, difenacoum, and difethialone over the course of 1 month. He developed severe VK-dependent coagulopathy (international normalized ratio, >26) with hematuria, necessitating discontinuation of rivaroxaban and initiation of intravenous, followed by long-term oral, VK1 therapy. Rivaroxaban was successfully reintroduced under close clinical and laboratory monitoring after several days of ongoing oral VK1 therapy.
CONCLUSION: This case demonstrates the feasibility of resuming DOAC therapy during VK1 treatment after LAAR poisoning.
KEY CLINICAL QUESTION: Can a direct oral anticoagulant (DOAC) be safely reintroduced in a patient at high risk of thrombosis recurrence whose LAAR poisoning is being managed with prolonged VK1 therapy?
CLINICAL APPROACH: We report the case of a patient receiving rivaroxaban for recurrent thrombosis who ingested massive amounts of brodifacoum, difenacoum, and difethialone over the course of 1 month. He developed severe VK-dependent coagulopathy (international normalized ratio, >26) with hematuria, necessitating discontinuation of rivaroxaban and initiation of intravenous, followed by long-term oral, VK1 therapy. Rivaroxaban was successfully reintroduced under close clinical and laboratory monitoring after several days of ongoing oral VK1 therapy.
CONCLUSION: This case demonstrates the feasibility of resuming DOAC therapy during VK1 treatment after LAAR poisoning.