Kuntheavy Ing Lorenzini, Youssef Daali, Pierre Fontana, Jules Desmeules, Caroline Samer
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.
Pharmacology, Toxicology and Pharmaceutical Science
10
24%
Medicine and Dentistry
8
19%
Social Sciences
2
5%
Agricultural and Biological Sciences
1
2%
Veterinary Science and Veterinary Medicine
1
2%
Other
2
5%
Unknown
18
43%
Attention Score in Context
Attention Score in Context
This research output has an Altmetric Attention Score of 1. This is our high-level measure of the quality and quantity of online attention that it has received. This Attention Score, as well as the ranking and number of research outputs shown below, was calculated when the research output was last mentioned on 23 July 2019.
All research outputs
#18,493,111
of 22,914,829 outputs
Outputs from Frontiers in Pharmacology
#8,302
of 16,206 outputs
Outputs of similar age
#309,973
of 420,355 outputs
Outputs of similar age from Frontiers in Pharmacology
#84
of 153 outputs
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So far Altmetric has tracked 16,206 research outputs from this source. They receive a mean Attention Score of 5.0. This one is in the 37th percentile – i.e., 37% of its peers scored the same or lower than it.
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