CASE REPORT   

Gazzetta Medica Italiana - Archivio per le Scienze Mediche 2020 July-August;179(7-8):474-8

DOI: 10.23736/S0393-3660.19.04039-7

Copyright © 2019 EDIZIONI MINERVA MEDICA

language: English

Efficacy and safety of rivaroxaban for secondary prevention in non-valvular atrial fibrillation after cardioembolic stroke complicated by hemorrhagic transformation: a case report with a 3-year follow-up

Simona GIUBILATO ✉, Guido GIORDANO, Marilena SCARABELLI, Francesco AMICO

Unit of Cardiology, Cannizzaro Hospital, Catania, Italy

Currently, the use of direct oral anticoagulants is recommended over vitamin K antagonists in patients with non-valvular atrial fibrillation for stroke prevention after stroke risk stratification. However, the choice of anticoagulant agent and the optimal time to start anticoagulation after a hemorrhagic event are complex decisions that must consider several aspects, including patient characteristics and clinical condition, and are even more challenging in patients with multiple stroke risk factors. Real-world data on the long-term management of patients with non-valvular atrial fibrillation at higher risk for stroke is still lacking. A 70-year-old woman with non-valvular atrial fibrillation, chronic kidney disease and a very high stroke and bleeding risk experienced a cardioembolic stroke followed by hemorrhagic transformation. Based on current recommendations, available clinical evidence, and the patient’s characteristics, particularly intracranial bleeding risk, anticoagulation with rivaroxaban at the low dose (i.e., 15 mg/day) was started early after hemorrhagic transformation. After 36 months of follow-up, the patient’s clinical conditions were good, with no thrombotic or hemorrhagic events. Our findings provide evidence of the long-term efficacy and safety of the early initiation of anticoagulation with low-dose rivaroxaban after a cardioembolic stroke complicated by hemorrhagic transformation, in a high-risk, female patient with non-valvular atrial fibrillation and chronic kidney disease.

KEY WORDS: Stroke; Rivaroxaban; Atrial fibrillation; Renal insufficiency, chronic; Secondary prevention