Rivaroxaban-induced hemorrhage – Acquired hemophilia as a rare cause

M. Kowar 1 , K. Wilhelm 2 , A.H. Jacobs 1 

1Department of Geriatrics, Johanniter Hospital Bonn, Germany; 2  Department of Radiology, Johanniter Hospital Bonn, Germany

Hemorrhage is a common problem associated with anticoagulation. After introduction of new oral anticoagulants (NOAC) a drug monitoring is no longer necessary. At advanced age, hemorrhage may become a serious side effect of NOAC, especially when other age-associated alterations such as impaired renal function occur. It has been reported that the frequency of fatal or major bleeding is less common under treatment with NOAC compared to Vitamin K antagonists 1. Here, we report a 88 years old woman with an abdominal hematoma without any accident. The cause of hemorrhage in this case is not due to a new started treatment under NOAC but newly diagnosed acquired hemophilia. Acquired hemophilia A is a rare autoimmune disorder caused by an autoantibody (inhibitor) to factor VIII (FVIII) that interferes with its coagulation function and predisposes to severe, potentially life-threatening hemorrhage 2. If acquired hemophilia is not detected, the combination with NOAC increases the risk for major potentially life-threatening bleeding.

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