ArticleJournal of Brown hospital medicine2024
Pulmonary Infarction Due to Direct-acting Oral Anticoagulant Malabsorption.
Article in Journal of Brown hospital medicine, 2024. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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4 authors.
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Abstract
A man in his 50s with a history of sleeve gastrectomy and rivaroxaban use for multiple venous thromboembolic events presented with subacute progressive cough. Axial images of a computerized tomography (CT) scan of the chest showed ground glass and consolidations within the right middle and right lower lobes, and he was treated for presumed community-acquired pneumonia. Given continued symptoms despite 7 days of antibiotics, his CT images were re-reviewed. Wedge shaped airspace disease more recognizable in sagittal views prompted concern for pulmonary infarction, and acquisition of a contrast-enhanced chest CT revealed interval increase of a prior pulmonary embolism and findings of acute on chronic thrombosis. Given the patient was adherent to rivaroxaban and had a negative hypercoagulable work-up, rivaroxaban malabsorption related to the patient's sleeve gastrectomy was invoked as the cause of anticoagulant failure, and the patient was successfully transitioned to warfarin therapy, highlighting malabsorption as a cause of recurrent VTE in patients who have received bariatric surgery and who take direct-acting oral anticoagulants.
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