Lesson of the month 2: Pulmonary embolism in a patient on rivaroxaban and concurrent carbamazepine

A 71-year-old female with a history of pulmonary embolism treated with rivaroxaban presented with acute onset shortness of breath, chest pain and palpitations. Computed tomographic pulmonary angiography (CTPA) revealed multiple bilateral pulmonary emboli. The patient was concurrently prescribed carb...

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Bibliographic Details
Published in:Clinical medicine (London, England) England), 2018-02, Vol.18 (1), p.103-105
Main Authors: Burden, Thomas, Thompson, Charlotte, Bonanos, Efstathios, Medford, Andrew RL
Format: Article
Language:English
Subjects:
Anticoagulants
Breast cancer
carbamazepine
Cardiac arrhythmia
CYP3A4
direct oral anticoagulants
Drug dosages
drug interactions
Embolisms
Enzymes
Family medical history
Health risk assessment
Heart
Lesson of the Month
Lymphatic system
NMR
Nuclear magnetic resonance
Pulmonary arteries
Pulmonary embolism
Pulmonary embolisms
rivaroxaban
Thromboembolism
Thrombosis
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Summary:A 71-year-old female with a history of pulmonary embolism treated with rivaroxaban presented with acute onset shortness of breath, chest pain and palpitations. Computed tomographic pulmonary angiography (CTPA) revealed multiple bilateral pulmonary emboli. The patient was concurrently prescribed carbamazepine and was later diagnosed with recurrence of breast cancer during the admission. We discuss common drug interactions pertinent to direct oral anticoagulants (DOACs) that can increase the risk of further venous thromboembolism. This case report highlights the importance of reviewing patient medications when considering anticoagulants and the need to raise awareness of these drug interactions among clinicians when making their choice of anticoagulation. It also reinforces the current lack of evidence for use of DOACs in patients with solid organ malignancies.
ISSN:1470-2118
1473-4893
DOI:10.7861/clinmedicine.18-1-103