Abnormal uterine bleeding induced by rivaroxaban in a patient with pulmonary embolism

Abstract

A 49-year-old female patient received anticoagulation therapy with rivaroxaban due to pulmonary embolism (initial dose: 15 mg, twice daily; maintenance dose 3 weeks later: 20 mg, once daily). From the month of treatment, the patient′s menstrual volume increased and menstrual period extended from 4-5 days to 8-9 days. Five months later, she developed anemia, with hemoglobin (Hb) 53 g/L. Uterine bleeding was considered to be related to rivaroxaban. Rivaroxaban was stopped, oxytocin and blood transfusion were given, and her anemia was improved. But 2 weeks later, pulmonary embolism recurred in the patient. Low-molecular-weight heparin and enoxaparin were given and 7 days later, enoxaparin was gradually adjusted to warfarin therapy (4.5 mg/d). The symptoms of chest tightness and short of breath were improved and anemia was Hb 125 g/L. After discharge, warfarin was taken continuously. At 1 month of follow-up, her INR was maintained at 2.00-3.33 and menstruation returned to normal. Key words: Anticoagulants; Rivaroxaban; Uterine hemorrhage; Warfarin