Symptomatic hepatocellular liver injury with hyperbilirubinemia in two patients treated with rivaroxaban.
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Publisher DOI
PubMed ID
25155865
Description
IMPORTANCE
Treatment with the new oral anticoagulant rivaroxaban can be associated with severe liver injury.
OBSERVATIONS
We report 2 patients with predominantly hepatocellular liver injury that had onset during treatment with rivaroxaban. Both were symptomatic, had massively elevated transaminase activity levels and hyperbilirubinemia, and fulfilled the criteria of Hy's law. Liver biopsy in 1 patient revealed centroacinar hepatocyte necrosis as the predominant finding. Both patients showed a rapid biochemical and clinical recovery after discontinuing rivaroxaban therapy. Between 2008 and 2013, 42 cases of liver injury possibly associated with rivaroxaban treatment have been reported to the Swiss Agency of Therapeutic Products (Swissmedic). Thirteen of these patients fulfilled the criteria of Hy's law.
CONCLUSIONS AND RELEVANCE
Treatment with rivaroxaban can be associated with severe, symptomatic liver injury. Physicians should be aware of this adverse drug reaction. We propose rapid discontinuation of treatment with rivaroxaban in case of symptomatic liver injury and, taking into account its severity, avoiding reexposure.
Treatment with the new oral anticoagulant rivaroxaban can be associated with severe liver injury.
OBSERVATIONS
We report 2 patients with predominantly hepatocellular liver injury that had onset during treatment with rivaroxaban. Both were symptomatic, had massively elevated transaminase activity levels and hyperbilirubinemia, and fulfilled the criteria of Hy's law. Liver biopsy in 1 patient revealed centroacinar hepatocyte necrosis as the predominant finding. Both patients showed a rapid biochemical and clinical recovery after discontinuing rivaroxaban therapy. Between 2008 and 2013, 42 cases of liver injury possibly associated with rivaroxaban treatment have been reported to the Swiss Agency of Therapeutic Products (Swissmedic). Thirteen of these patients fulfilled the criteria of Hy's law.
CONCLUSIONS AND RELEVANCE
Treatment with rivaroxaban can be associated with severe, symptomatic liver injury. Physicians should be aware of this adverse drug reaction. We propose rapid discontinuation of treatment with rivaroxaban in case of symptomatic liver injury and, taking into account its severity, avoiding reexposure.
Date of Publication
2014-10
Publication Type
Article
Language(s)
en
Contributor(s)
Rätz Bravo, Alexandra E | |
Terracciano, Luigi | |
Heim, Markus | |
Krähenbühl, Stephan |
Additional Credits
Series
JAMA Internal Medicine
Publisher
American Medical Association
ISSN
2168-6114
Access(Rights)
metadata.only