Key result
Discontinuation of rivaroxaban for a renal biopsy in a 73-year-old woman with nephrotic syndrome and atrial fibrillation resulted in acute brachial arterial embolic occlusion.
Case Report (n=1)
No
Discontinuation of anticoagulation for renal biopsy in patients with concurrent thrombotic risk factors (like nephrotic syndrome and atrial fibrillation) can lead to severe acute thromboembolic events.
Brief rivaroxaban interruption for biopsy may precipitate embolism in AF with nephrotic syndrome; leaves open optimal periprocedural strategies.
A 73-year-old woman with atrial fibrillation treated with rivaroxaban was hospitalized for nephrotic syndrome. After discontinuation of rivaroxaban to lower the risk of hemorrhagic events, a renal biopsy was performed. Rivaroxaban was scheduled to resume a week after the biopsy to prevent renal hemorrhaging. However, she developed acute brachial arterial embolic occlusion and mural thrombosis in the abdominal aorta before resuming rivaroxaban. If immune-mediated renal diseases are suspected in anticoagulated patients at a risk of thrombotic events, physicians should consider initiating glucocorticoid therapy without a renal biopsy in order to avoid hemorrhagic and thrombotic events.
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Taniguchi et al. (2021) conducted a case report in Nephrotic syndrome and atrial fibrillation (n=1). Anticoagulant discontinuation (rivaroxaban) was evaluated on Development of thromboembolism (acute brachial arterial embolic occlusion). Discontinuation of rivaroxaban for a renal biopsy in a 73-year-old woman with nephrotic syndrome and atrial fibrillation resulted in acute brachial arterial embolic occlusion.
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