Rivaroxaban treatment failure during COVID-19 infection

ABSTRACT

Background: The Coronavirus Disease 2019 (COVID-19) has been shown to Increase incidence of venous thromboembolism (VTE). We describe a novel case of rivaroxaban treatment failure in a patient with COVID-19 infection who previously demonstrated efficacious treatment of prior pulmonary embolism (PE) with rivaroxaban Case presentation A 75-year-old male patient originally presented for syncope and was found to have acute submissive PE on Computed tomography angiogram of his (CTA) chest. He was placed on heparin initially and he remained hemodynamically stable during his admission and was discharged home on rivaroxaban at standard induction dose. He presented again for shortness of breath 3 months later. CTA chest was repeated and demonstrated resolution of his prior PE. He was found to be positive for COVID-19 and admitted for further management, rivaroxaban was continued during his admission. Repeat CTA of his chest 2 weeks later demonstrated moderate right and small left PE without right heart strain. Vascular Medicine was consulted at that time. The patient reported taking his rivaroxaban as directed throughout the recommended course. He reported taking rivaroxaban with food. He said his son helped him with his medications and it was unlikely he missed any doses. He was able to get his medications from the Veterans Health Administration (VA) and had no issues with access to medications. Medication review revealed no drug interactions . that would decrease efficacy of rivaroxaban. The patient's weight of 116 kg was within the acceptable range for rivaroxaban use. Conclusion(s) This case is unique in that timing of CTA scans demonstrated complete resolution of patient's initial PE while taking rivaroxaban followed by new development of PE after COVID-19 infection despite continuation of rivaroxaban therapy.