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Rivaroxaban-Induced Hemorrhage Associated with ABCB1 Genetic Defect

Published inFrontiers in pharmacology, vol. 7, 494
Publication date2016
Abstract

We report a patient who presented a non-ST segment elevation myocardial infarction in the context of severe normocytic hypochromic anemia related to gastrointestinal bleeding, 3 months after switching anticoagulant from the vitamin K antagonist acenocoumarol to the direct oral anticoagulant rivaroxaban. High levels of both anti-Xa activity and rivaroxaban plasma concentrations were measured despite rivaroxaban withdrawal, suggesting reduced elimination/drug clearance. Estimated half-life was 2-3 times longer than usually reported. The patient is a homozygous carrier of ABCB1 variant alleles, which could have participated to reduced elimination of rivaroxaban. Furthermore, CYP3A4/5 phenotyping showed moderately reduced enzyme activity. Drug-drug interaction with simvastatin may have contributed to decreased rivaroxaban elimination. Although in the present case moderate acute renal failure probably played a role, more clinical data are required to elucidate the impact of ABCB1 polymorphism on rivaroxaban pharmacokinetics and bleeding complications.

Citation (ISO format)
ING LORENZINI, Kuntheavy et al. Rivaroxaban-Induced Hemorrhage Associated with ABCB1 Genetic Defect. In: Frontiers in pharmacology, 2016, vol. 7, p. 494. doi: 10.3389/fphar.2016.00494
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ISSN of the journal1663-9812
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