Rivaroxaban use during vitamin K1 therapy for rodenticide poisoning.

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.