Rivaroxaban-induced hemorrhage – Acquired hemophilia as a rare cause
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.
This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.
© Società Italiana di Gerontologia e Geriatria (SIGG) , 2017
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