SUMMARY

• 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 (NSAIDs), selective serotonin reuptake inhibitors, and serotonin norepinephrine reuptake inhibitors.¹
• There are no specific studies that evaluated the concomitant use of XARELTO and cilostazol.
• A case report of an 86-year-old male describes the concomitant use of XARELTO and cilostazol.²
• An additional reference identified during a literature search is included in the reference section for your review.³

Case Report

An 86-year-old, frail, male patient, with multiple comorbidities, was admitted to the hospital for critical lower limb ischemia. Medical history includes non-valvular atrial fibrillation, dyslipidemia, chronic obstructive pulmonary disease, megaloblastic anemia, and mild to moderate chronic kidney disease. Examination revealed multiple steno-obstructive lesions, ankle-brachial index of about 0.3-0.35 in both legs, and fibrocalcific atherosclerotic plaques in lower limb arteries. Patient began intravenous heparin and both aspirin 100mg/day and clopidogrel 75mg/day. The patient was discharged after 10 days and continued clopidogrel 75mg/day along with warfarin. After 3 months of therapy the patient was switched to rivaroxaban 15mg/day (creatinine clearance 15ml/min-49ml/min) and cilostazol at a starting dose of 150mg/day which was increased up to 200mg/day. Limb perfusion was good and there was no major or minor hemorrhagic or thrombotic events after approximately 32 months from start of therapy. The limb was saved and blood count, coagulation, serum creatinine, and liver function were stable. Patient died of acute respiratory insufficiency due to severe pulmonary infection after his last follow-up.²

Literature Search

A literature search of MEDLINE^® (and/or other resources, including internal/external databases) pertaining to this topic was conducted on 04 September 2024.