Abstract
Direct oral anticoagulants have become more popular in recent years and have largely replaced vitamin K antagonists in the treatment of certain conditions, such as stroke prevention in atrial fibrillation and venous thromboembolism. Rivaroxaban is one of the direct oral anticoagulants that inhibit factor Xa and a rare cause of peritoneal haemorrhage which is uncommon and life-threatening complication. In this report, we present a 29-year-old female patient using rivaroxaban due to deep vein thrombosis after pregnancy and developing intraperitoneal hemorrhage around terminal ileum and cecum clinically mimicking acute appendicitis.
Highlights
For many decades, vitamin K antagonists (VKAs) had been the standard anticoagulation regimen in indications of stroke prevention in atrial fibrillation (SPAF) and treatment of venous thromboembolism (VTE) [1]
VKAs have a great number of food–drug and drug–drug interactions
Co-prescribed drugs interacting with VKAs are antibiotics, diuretics and nonsteroidal anti-inflammatory drugs (NSAIDs)
Summary
Vitamin K antagonists (VKAs) had been the standard anticoagulation regimen in indications of stroke prevention in atrial fibrillation (SPAF) and treatment of venous thromboembolism (VTE) [1]. Direct oral anticoagulants (DOAC) are increasingly prefered over VKA because of rapid onset and offset of action, having more predictable pharmacodynamics, lower potential of food drug or drugdrug interactions and fewer bleeding complications [4]. A 29-year-old woman presented to the emergency department with complaints of right lower quandrant (RLQ) pain and vomiting for 1 day She was receiving rivaroxaban 20 mg once a day because the history of deep vein thrombosis after labor 3 months ago and was healthy until beginning of abdominal pain. Abdominal computed tomography (CT) was planned to confirm diagnosis It revealed appendiceal dilatation (9.1mm), mild pericecal appendicular fat heterogeneity and pericecal fluid accumulation (Figure 1). The patient was stable after discontinuation of rivaroxaban and hemoglobin level was not dropping She was discharged 4 days after surgery
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