Spontaneous Hemopericardium as an Adverse Effect of Rivaroxaban Administration

Abstract

Rivaroxaban is a direct oral anticoagulant with a favorable safety profile when compared to warfarin in respect to bleeding. During post-marketing surveillance, intracranial and retroperitoneal bleedings have been reported; however, hemopericardium has not been frequently described. In this case series, we present three cases of spontaneous hemopericardium where rivaroxaban was thought to be the causative agent. Predisposing factors for rivaroxaban induced hemopericardium might include impaired kidney function, concomitant use of antiplatelet agents, herbal supplements, and CYP3A4 metabolizers and inhibitors. Clinicians should be aware of the possibility of such life-threatening adverse event in patients taking rivaroxaban and should consider it in their differential diagnosis in a patient presenting with chest pain and/or dyspnea while on rivaroxaban. This case series suggests that rivaroxaban induced hemopericardium might not be as rare as initially thought. CAsE REPoRt