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02 November 2019 : Case report  USA

Rivaroxaban Related Bilateral Adrenal Hemorrhage: A Rare Complications of Direct Oral Anticoagulants – A Case Reports

Challenging differential diagnosis, Unusual or unexpected effect of treatment, Diagnostic / therapeutic accidents, Unexpected drug reaction , Rare disease, Educational Purpose (only if useful for a systematic review or synthesis)

Marjan Alidoost1EF, Rabail Soomro1F, Ana Gubeladze1F, Albert Morabia1F, Soemiwati Holland1F, Arif Asif1EF, Mohammad A. Hossain1EF*

DOI: 10.12659/AJCR.917780

Am J Case Rep 2019; 20:1607-1611

Abstract

BACKGROUND: Adrenal hemorrhage is an uncommon and under-recognized disorder with a wide array of etiologies ranging from pregnancy to septic shock. It is one of the complications of anticoagulation therapy, including direct anticoagulant medications.

CASE REPORT: Here, we present a case of a 68-year-old female with recent right knee arthroplasty who was on rivaroxaban for deep vein thrombosis (DVT) prophylaxis presented to the emergency department (ED) for severe acute onset abdominal pain, computed tomography (CT) of abdomen and pelvis revealed possible left adrenal hemorrhage that was confirmed with magnetic resonance imaging (MRI). On repeat CT, her unilateral adrenal hemorrhage converted to a bilateral adrenal hemorrhage (BAH) and, as a result, the patient developed adrenal insufficiency.

CONCLUSIONS: An undiagnosed and untreated adrenal hemorrhage can have catastrophic consequences, leading to adrenal insufficiency with potential shock and death. Therefore, it is important for clinicians to have an increased awareness and knowledge about adrenal hemorrhage.

Keywords: adrenal insufficiency, Anticoagulants, Arthroplasty, Replacement, Knee, Abdominal Pain, Adrenal Glands, Aged, Factor Xa Inhibitors, Hemorrhage, Rivaroxaban

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American Journal of Case Reports eISSN: 1941-5923
American Journal of Case Reports eISSN: 1941-5923