rivaroxaban / Generic mfg. - LARVOL DELTA

Treatment of Antithrombotic-Associated Intracranial Hemorrhage in Adults: A Focused Guideline Update from the Neurocritical Care Society and the Society of Critical Care Medicine. (PubMed, Neurocrit Care) - "The guideline writing panel provided new conditional recommendations for the treatment of antithrombotic-associated acute ICH. These recommendations are intended for consideration along with the patient's clinical status and patient-specific factors."

Journal • Cerebral Hemorrhage • CNS Disorders • Critical care • Hematological Disorders • Subarachnoid Hemorrhage • Vascular Neurology

Flood Syndrome Secondary to BuddâChiari Syndrome: A Case Report (ACG 2026) - "Prophylactic ceftriaxone, metronidazole were given and patient was optimized on a spironolactone and torsemide regimen to reduce ascitic fluid pressure. The patient was instructed on regular follow-up and strict compliance to her BCS regimen including rivaroxaban, carvedilol...This case expands the etiological spectrum of Flood syndrome and emphasizes that BCS should be considered as a potential cause in patients presenting with spontaneous umbilical ascitic leakage. Figure: Picture depicting the sinus tract on skin"

Case report • Clinical • Cardiovascular • Fibrosis • Gastroenterology • Hepatology • Immunology • Infectious Disease • Portal Hypertension • Thrombosis

Paradoxical Thrombocytosis in Cirrhosis: A Clue to Underlying JAK2-Positive Myeloproliferative Neoplasm (ACG 2026) - "Case Description/ A 76-year-old male with alcohol use disorder and atrial fibrillation on rivaroxaban presented with a large spontaneous intramuscular hematoma...The individual boxes represent the ten valid shear-wave acquisitions used to calculate the reported median stiffness values. The calculated splenic-hepatic elastography index was 1.27."

Addiction (Opioid and Alcohol) • Atrial Fibrillation • Cardiovascular • Essential Thrombocythemia • Fibrosis • Hematological Disorders • Hepatology • Immunology • Myeloproliferative Neoplasm • Portal Hypertension • Thrombocytosis • Thrombosis • JAK2

Comparative Effectiveness and Safety of Apixaban vs Rivaroxaban in Patients With Cirrhosis and Atrial Fibrillation: A Propensity-Matched TriNetX Analysis (ACG 2026) - ": At 12 months, rivaroxaban vs apixaban showed no meaningful differences in: stroke (7.1% vs 6.6%; RR 1.08, 95% CI 0.82â1.41), intracranial hemorrhage (4.4% vs 4.8%; RR 0.93, 0.68â1.28; KM HR 0.69, 0.36â1.33), major GI bleeding (18.3% vs 17.2%; RR 1.06, 0.89â1.26; KM HR 1.05, 0.80â1.39), and all-cause mortality (18.7% vs 19.8%; RR 0.94, 0.81â1.10). Early outcomes at 90 days were similarly comparable for stroke (3.1% vs 3.7%; KM HR 0.83, 0.59â1.15), major GI bleeding (6.7% vs 5.4%; KM HR 1.29, 0.96â1.72), and mortality (10.0% vs 9.7%; KM HR 1.03, 0.82â1.29). Longer-term mortality also remained similar at 2 years (KM HR 1.00, 0.87â1.16) and 3 years (KM HR 1.06, 0.85â1.33)."

Clinical • HEOR • Atrial Fibrillation • Cardiovascular • Cerebral Hemorrhage • CNS Disorders • Fibrosis • Gastrointestinal Disorder • Hematological Disorders • Hepatology • Immunology • Ischemic stroke

Concurrent Aspirin Use in Anticoagulated Patients and Risk of Gastrointestinal Bleeding: A Propensity-Score-Matched Cohort Analysis (ACG 2026) - "Cohort 1 comprised adults on chronic anticoagulation (apixaban, rivaroxaban, dabigatran, edoxaban, or warfarin) with concurrent aspirin use; Cohort 2 comprised anticoagulated adults without aspirin. Post-PSM cohorts were well-balanced (all SMDs < 0.003). Aspirin use was associated with significantly higher rates of upper GI bleed (1.51% vs. 1.26%; HR 1.34, 95% CI 1.20â1.48; p< 0.001), unspecified GI hemorrhage (1.39% vs."

Clinical • Cardiovascular • Chronic Kidney Disease • Gastroenterology • Gastrointestinal Disorder • Hematological Disorders • Renal Disease • Thrombocytopenia

A Rare Case of Amebic Liver Abscess Complicated by Extensive IVC Thrombosis (ACG 2026) - "He was discharged on oral rivaroxaban and diloxanide furoate...Figure: Axial contrast-enhanced CT image showing a filling defect within a hepatic vein extending into the intrahepatic IVC. Figure: Coronal CECT abdomen showing multiple bilateral rim-enhancing hepatic lesions (green arrows) with attenuation of the right posterior segmental portal vein branch by a segment V lesion (red arrow)."

Clinical • Cardiovascular • Hematological Disorders • Hepatology • Infectious Disease • Metabolic Disorders • Thrombocytopenia • Thrombosis

GI-Predominant IgA Vasculitis in a Geriatric Patient (ACG 2026) - "Case Description/ Our patient is an 82-year-old female with atrial fibrillation on rivaroxaban that presented with melena, abdominal pain, and 2 weeks of bilateral lower-extremity purpura...A trial of enoxaparin resulted in hematochezia requiring transfusion...These were also present in the second and fourth parts of the duodenum. The ileitis seen on colonoscopy had a similar appearance."

Clinical • Acute Kidney Injury • Atrial Fibrillation • Cardiovascular • Crohn's disease • Focal Segmental Glomerulosclerosis • Gastroenterology • Gastrointestinal Disorder • Geriatric Disorders • Glomerulonephritis • Immunology • Infectious Disease • Inflammation • Inflammatory Bowel Disease • Lupus Nephritis • Nephrology • Renal Disease • Vasculitis

Downstream Bleed: A Case of Venous Lakes as a Source of Small Bowel Bleeding (ACG 2026) - "Case Description/ An 80-year-old man with atrial fibrillation on rivaroxaban, chronic gastroduodenal fistula, and prior aortoiliac endovascular aneurysm repair was transferred to UIH for recurrent OGIB after multiple admissions for melena...This case demonstrates the importance of considering all possibilities, including venous lakes, in the differential diagnosis of OGIB. It highlights the value of both VCE and device-assisted enteroscopy in diagnosing and managing rare vascular lesions of the small intestine."

Clinical • Atrial Fibrillation • Cardiovascular • Gastroenterology • Gastrointestinal Disorder

Treatment of Malignant GI Bleeding With Brachytherapy (ACG 2026) - "Case Description/ A 92-year-old male with multiple comorbidities, including atrial fibrillation on rivaroxaban and prior laryngeal cancer status post laryngectomy with permanent tracheostomy; was newly diagnosed with esophageal squamous cell carcinoma during bidirectional endoscopy for investigation of iron deficiency anemia...Further investigation is needed to determine whether brachytherapy may represent a safe and durable treatment option for selected patients with malignant GIB. Figure: Endoscopic view of bleed from a maliganant source."

Atrial Fibrillation • Esophageal Cancer • Esophageal Squamous Cell Carcinoma • Gastroenterology • Gastrointestinal Disorder • Head and Neck Cancer • Laryngeal Cancer • Solid Tumor • Squamous Cell Carcinoma

Serotonergic Agents Amplify Gastrointestinal Bleeding and Clinical Risk Across All Antithrombotic Regimen Strata: A Real-World Analysis (ACG 2026) - "Within each of four antithrombotic strata, (1) SAPT (aspirin or clopidogrel), (2) DOAC monotherapy (rivaroxaban or apixaban), (3) DAPT (aspirin + clopidogrel), and (4) DOAC + SAPT, patients with concurrent SSRI/SNRI were compared to unexposed controls. Across all four strata, SSRI/SNRI co-prescription was associated with significantly elevated risk of all nine outcomes (all p < 0.001). Upper GI bleeding RR: 2.19, NNH 71 (SAPT), 1.68 (DOAC), 1.99 (DAPT), 1.73 (DOAC+SAPT). EGD rates were the most striking, with RR 2.57 in DAPT patients (NNH 31) and RR 2.41 in SAPT (NNH 38) demonstrating a significant procedural burden."

Clinical • Real-world • Real-world evidence • Cardiovascular • Gastroenterology • Gastrointestinal Disorder

Advanced Endoscopic Features of Severe HSV Esophagitis in an Immunocompromised Host (ACG 2026) - "Her medical history was notable for metastatic ovarian cancer on third-line chemotherapy, stage 3 diffuse large B-cell lymphoma treated with R-CHOP, and deep vein thrombosis treated with an IVC filter and rivaroxaban...The patient was started on pantoprazole twice daily...She was later evaluated by an infectious disease consultant who recommended continuing valacyclovir for prophylaxis while immunosuppressed...Figure: Figure 1. Upper endoscopy showing severe esophagitis starting in the mid-esophagus (A) and extending distally (B,C) to the gastroesophageal junction (not shown)"

Metastases • B Cell Lymphoma • Bone Marrow Transplantation • Diffuse Large B Cell Lymphoma • Gastroenterology • Gastroesophageal Reflux Disease • Gastrointestinal Disorder • Hematological Malignancies • Herpes Simplex • Human Immunodeficiency Virus • Infectious Disease • Lymphoma • Non-Hodgkin’s Lymphoma • Ovarian Cancer • Solid Tumor • Thrombosis

Evolving Non-Transplant Biliary Cast Syndrome After Septic Shock: A Nondiagnostic Initial ERCP Does Not Exclude the Diagnosis (ACG 2026) - "Case Description/ A 74-year-old male with atrial fibrillation on rivaroxaban, diabetes mellitus, and HFpEF presented with right upper quadrant pain, nausea, and emesis...Figure: Image 1 (Pre-Balloon Sweep): Yellow arrows indicate biliary filling defects. Figure: Image 2 (Post-Balloon Sweep): Green arrows indicate interval improvement of filling defects after balloon sweep."

Atrial Fibrillation • Cardiovascular • Diabetes • Gastroenterology • Hepatology • Liver Failure • Metabolic Disorders • Septic Shock • Transplantation

Troubled Waters: A Jejunal Venous Lake as a Rare Cause of Gastrointestinal Bleeding (ACG 2026) - "Case Description/ An 80-year-old male with stage III chronic kidney disease, atrial fibrillation on rivaroxaban, coronary artery disease, aortic aneurysm status-post endovascular repair, and ischemic cardiomyopathy presented to our hospital with recurrent melena of unidentified source...Figure: Jejunal phlebectasia visualized on anterograde double balloon endoscopy. Figure: Jejunal phlebectasia status post hemostatic clipping via anterograde double balloon endoscopy."

Atrial Fibrillation • Cardiomyopathy • Cardiovascular • Chronic Kidney Disease • Coronary Artery Disease • Gastroenterology • Gastrointestinal Disorder • Nephrology • Renal Disease

Unusual Case of Hematochezia From a Malpositioned Inferior Vena Cava Filter Eroding into Duodenum (ACG 2026) - "Case Description/ 77-year-old male with history of esophageal cancer (status post esophagectomy over 20 years ago, currently in remission), ulcerative colitis (in remission on mesalamine), deep vein thrombosis/pulmonary embolism (had IVC filter placed many years ago which was known to be malpositioned), atrial fibrillation (on rivaroxaban), presented to the emergency department with middle abdominal pain, multiple bloody bowel movements and syncope...The US Food and Drug Administration issued a warning regarding the timely removal of retrievable filters as soon as protection from pulmonary embolism is no longer needed. Figure: EGD Figure: Colonoscopy"

Clinical • Atrial Fibrillation • Esophageal Cancer • Gastroenterology • Gastrointestinal Disorder • Immunology • Inflammatory Bowel Disease • Musculoskeletal Diseases • Respiratory Diseases • Ulcerative Colitis • Venous Thromboembolism

Master of Disguise: Hemophagocytic Lymphohistiocytosis Masking as Acute Liver Failure (ACG 2026) - "Case Description/ A 74-year-old female with a medical history of atrial fibrillation on rivaroxaban, bipolar II disorder, and alcohol use disorder presented for abdominal pain...In our patient, her laboratory derangements initially indicated ischemic or toxic injury; however, the absence of a clear insult, combined with marked hyperferritinemia and cytopenias, prompted further evaluation and led to the likely diagnosis of HLH, utilizing the HScore. This case highlights the need to tailor the differential to the clinical context and consider rare etiologies in unexplained severe liver injury."

Addiction (Opioid and Alcohol) • Atrial Fibrillation • Bipolar Disorder • Cardiovascular • CNS Disorders • Hemophagocytic lymphohistiocytosis • Hepatology • Immunology • Infectious Disease • Liver Failure • Rare Diseases • Thrombosis

From Palliation to Predicament: A Cascade of Rare Complications Following Endoscopic Management of Malignant Biliary Obstruction (ACG 2026) - "Case Description/ A 73-year-old man with stage IIA intrapancreatic CCA on chemotherapy and pulmonary embolism on rivaroxaban presented with hematochezia and hemorrhagic shock 2 weeks after ERCP with uncovered metal stent placement for a high-grade malignant common bile duct stricture...Although each complication has been individually described, their occurrence in succession is exceedingly rare. In patients with advanced CCA and poor prognosis, the cumulative burden of repeated interventions may surpass their intended palliative benefit, reinforcing the need for continual reassessment of goals of care and individualized risk-benefit discussions."

Cardiovascular • Cholangiocarcinoma • Hepatology • Pulmonary Embolism • Respiratory Diseases • Solid Tumor

When Hemorrhoids Are Not the Answer: Transverse Colonic Dieulafoy Lesion Presenting as Hematochezia in an Anticoagulated Elderly Patient (ACG 2026) - "Case Description/ A 78-year-old man with atrial fibrillation on rivaroxaban, hypertension, type 2 diabetes mellitus, obstructive sleep apnea, and hypothyroidism presented with hematochezia and a hemoglobin decline from 9.4 to 8.4 g/dL...Epinephrine injection demonstrating effective mucosal blanching...F. Colonoscopic tattoo marking adjacent to the successfully treated Dieulafoy lesion in the transverse colon."

Clinical • Atrial Fibrillation • Cardiovascular • Colonic Polyps • Diabetes • Endocrine Disorders • Gastroenterology • Gastrointestinal Disorder • Hematological Disorders • Hypertension • Metabolic Disorders • Obstructive Sleep Apnea • Respiratory Diseases • Sleep Disorder • Type 2 Diabetes Mellitus

Coexistence of Gastric Antral Vascular Ectasia and Hemosuccus Pancreaticus in a Patient With Metastatic Cholangiocarcinoma Diagnosed by Small Bowel Capsule Endoscopy (ACG 2026) - "Case Description/ An 83-year-old man with metastatic cholangiocarcinoma treated with gemcitabine/cisplatin/nab-paclitaxel, FOLFOX, and olaparib, and atrial fibrillation on rivaroxaban, presented with progressive transfusion-dependent anemia and intermittent melena...Third, and most critically, hemosuccus pancreaticus may herald cholangiocarcinoma recurrence, serving here as the index finding that prompted confirmatory multimodal imaging. Clinicians should maintain high suspicion for concurrent bleeding etiologies and consider capsule endoscopy early when standard evaluation is inconclusive."

Clinical • Metastases • Atrial Fibrillation • Biliary Cancer • Cardiovascular • Cholangiocarcinoma • Gastroenterology • Gastrointestinal Disorder • Oncology • Solid Tumor

Impact of Non-Vitamin K Antagonist Oral Anticoagulants on Cardiovascular Outcomes in Diabetes Patients with Atrial Fibrillation: A Single-Center Experience. (PubMed, Acta Cardiol Sin) - "This retrospective cohort study included patients with DM and AF treated with NOACs (apixaban, dabigatran, edoxaban, or rivaroxaban) between December 2012 and June 2022 at a tertiary hospital in Taiwan. In this single-center study, the risk of major bleeding was similar across the four NOACs. In addition, dabigatran was associated with lower risks of MACEs and all-cause mortality compared with apixaban."

Journal • Atrial Fibrillation • Cardiovascular • Cerebral Hemorrhage • CNS Disorders • Diabetes • Gastroenterology • Hematological Disorders • Ischemic stroke • Metabolic Disorders • Myocardial Infarction

Development and validation of a novel rivaroxaban calibrator: A routine anti-Xa assay solution with high agreement with LC-MS/MS. (PubMed, Thromb Res) - "The CX-9010 assay demonstrated strong agreement with LC-MS/MS in this single-center cohort. The calibrator quality met all predefined targets, supporting its use for routine clinical monitoring; multicenter validation is warranted before broader claims of interchangeability can be made."

Journal

Impact of Cytochrome P450 and P-glycoprotein Gene Polymorphisms on the Risk of Hemorrhagic Complications in Older Patients with Non-Valvular Atrial Fibrillation Treated with Rivaroxaban. (PubMed, J Pers Med) - "The leading non-genetic factors associated with hemorrhage were advanced age (p < 0.0001), progressive glomerular filtration rate decline (CKD stages 3b-4; p = 0.0009), and pharmacokinetic/pharmacodynamic interference from the co-administration of amiodarone (OR 3.61), non-steroidal anti-inflammatory drugs, and antiplatelet agents. Implementing pharmacogenetic testing of the P-glycoprotein transporter combined with a rigorous audit of renal excretory function and concomitant therapy management may optimize the safety profile of rivaroxaban in geriatric practice. These findings warrant confirmation in a larger cohort."

Journal • Atrial Fibrillation • Cardiovascular • Chronic Kidney Disease • Geriatric Disorders • Hematological Disorders • ABCB1 • CYP3A4 • CYP3A5

Adherence to Direct Oral Anticoagulants in Patients With Non-valvular Atrial Fibrillation: A Single-Center Retrospective Study. (PubMed, J Cardiovasc Pharmacol Ther) - "Adherence levels for dabigatran, rivaroxaban, apixaban, and edoxaban were compared at 3, 6, 9, and 12 months. The NVBP policy improves adherence short-term, but long-term effects are limited. Targeted interventions are necessary for high-risk populations."

Clinical • Journal • Retrospective data • Atrial Fibrillation • Cardiovascular • Diabetes • Metabolic Disorders

ABCB1 genotype and clinically relevant bleeding risk during extended anticoagulation therapy for pulmonary embolism: a two-phase study. (PubMed, Res Pract Thromb Haemost) - "ABCB1 rs1045642 showed a nominal association with CRB and higher rivaroxaban peak plasma concentration during extended therapy. Adding this genotype to existing bleeding scores improved risk reclassification but not overall discrimination, and its clinical utility requires independent prospective validation."

Journal • Cardiovascular • Pulmonary Embolism • Respiratory Diseases • Venous Thromboembolism • ABCB1

Thromboprophylaxis in Patients Undergoing Orthopedic Surgeries; Using Propensity Score Matching (clinicaltrials.gov) - P=N/A | N=0 | Withdrawn | Sponsor: Hanoi Medical University | N=4000 ➔ 0 | Unknown status ➔ Withdrawn

Enrollment change • Trial withdrawal • Cardiovascular • Hematological Disorders • Orthopedics • Thrombosis • Venous Thromboembolism

Full versus abbreviated lead-in durations of apixaban and rivaroxaban after initial parenteral anticoagulation in the treatment of venous thromboembolism. (PubMed, Thromb Res) - No abstract available

Journal • Cardiovascular • Venous Thromboembolism