Abstract
BackgroundMany patients with critical lower limb ischemia are not eligible for revascularization procedures. Still, given the emerging role of both platelet and coagulation activation in the formation of arterial thrombi, they may benefit from the novel anticoagulant and antiplatelet drugs.Case presentationWe describe the case of a male with critical lower limb ischemia complicated by older age, frailty, polymorbidity and non valvular atrial fibrillation, who was deemed as non eligible for surgery. The patient was successfully treated with the combination of rivaroxaban and cilostazol, and the clinical benefit was maintained throughout 32 months, with no occurrence of major or minor hemorrhagic or thrombotic events.ConclusionsTo our knowledge, this is the first report on the efficacy and safety of such a combination therapy in critical lower limb ischemia. In a clinical setting in which alternative pharmacological approaches are urgently needed, the association of rivaroxaban and cilostazol warrants further investigations.
Highlights
Many patients with critical lower limb ischemia are not eligible for revascularization procedures
Rivaroxaban belongs to the class of the direct oral anticoagulants (DOACs), currently considered an advantageous alternative to the standard oral anticoagulants
Over the following 3 months, the International normalized ratio (INR) ranged between 2 and 3.5 in only 45% of evaluations, the patient was switched to rivaroxaban 15 mg/day plus cilostazol, which was started at the dose of 150 mg/ day and increased up to 200 mg/day
Summary
This is the first report on the efficacy and safety of such a combination therapy in critical lower limb ischemia.
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