Pulmonary Infarction Due to Direct-acting Oral Anticoagulant Malabsorption.

Publication/Presentation Date

1-1-2024

Abstract

A man in his 50s with a history of sleeve gastrectomy and rivaroxaban use for multiple venous thromboembolic events presented with subacute progressive cough. Axial images of a computerized tomography (CT) scan of the chest showed ground glass and consolidations within the right middle and right lower lobes, and he was treated for presumed community-acquired pneumonia. Given continued symptoms despite 7 days of antibiotics, his CT images were re-reviewed. Wedge shaped airspace disease more recognizable in sagittal views prompted concern for pulmonary infarction, and acquisition of a contrast-enhanced chest CT revealed interval increase of a prior pulmonary embolism and findings of acute on chronic thrombosis. Given the patient was adherent to rivaroxaban and had a negative hypercoagulable work-up, rivaroxaban malabsorption related to the patient's sleeve gastrectomy was invoked as the cause of anticoagulant failure, and the patient was successfully transitioned to warfarin therapy, highlighting malabsorption as a cause of recurrent VTE in patients who have received bariatric surgery and who take direct-acting oral anticoagulants.

Volume

3

Issue

1

First Page

90274

Last Page

90274

ISSN

2994-5593

Disciplines

Diagnosis | Medicine and Health Sciences | Other Analytical, Diagnostic and Therapeutic Techniques and Equipment | Radiology

PubMedID

40027385

Department(s)

Department of Radiology and Diagnostic Medical Imaging

Document Type

Article

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