SUMMARY

• Rivaroxaban is a substrate of cytochrome P450 (CYP) 3A4/5, CYP2J2, and the P-glycoprotein (P-gp) and ATP-binding cassette G2 transporters. Combined P-gp and strong CYP3A inhibitors increase exposure to rivaroxaban and may increase the risk of bleeding. Combined P-gp and strong CYP3A inducers decrease exposure to rivaroxaban and may increase the risk of thromboembolic events.¹
• Concomitant use of drugs affecting hemostasis increases the risk of bleeding during XARELTO therapy. These include aspirin, P2Y12 platelet inhibitors, dual antiplatelet therapy, other antithrombotic agents, fibrinolytic therapy, nonsteroidal anti-inflammatory drugs, selective serotonin reuptake inhibitors, and serotonin norepinephrine reuptake inhibitors.¹
• A case report of a patient with migratory superficial venous thrombosis (SVT) and a history of chronic cannabis use who received XARELTO for the prevention of deep vein thrombosis (DVT) has been summarized below.²

CASE REPORT

Smith et al (2022)² reported the case of a 16-year-old Caucasian male with migratory SVT associated with thromboangiitis obliterans (TAO). The patient presented with left inguinal and posterior thigh pain, tenderness, and overlying erythema. Risk factors for thrombus were chronic cannabis use, a remote history of Kawasaki disease, and a family history of limited cutaneous systemic sclerosis. An ultrasound (US) revealed a thrombus in the left greater saphenous vein. To prevent DVT, XARELTO 20 mg once daily was initiated.

After using XARELTO for 2 months, the patient experienced progressive and refractory erythema, pain, and tenderness, with palpable upper and lower extremity superficial thromboses. A repeat US revealed SVT progression, and Doppler US did not show lower extremity DVT. Anticoagulation therapy was changed to low-molecular-weight heparin (LMWH) with symptomatic relief.

Literature Search

A literature search of MEDLINE^®, EMBASE^®, BIOSIS Previews^®, and DERWENT^® (and/or other resources, including internal/external databases) was conducted on 07 February 2024.