Temporary withdrawal of NOACs like rivaroxaban may lead to rebound hypercoagulability and venous thrombosis, particularly in patients with indwelling devices like pacemakers.
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Highlights the potential for rebound hypercoagulability when interrupting NOACs in patients with pac.
As the newer oral anticoagulants (NOACs) are increasingly used in older patients, clinical scenarios when they may need to be discontinued temporarily or indefinitely, may be encountered. Similarly with increasing use of permanent pacemakers and other intra-cardiac devices, there is an increased risk of upper limb venous thrombosis even few years after their insertion. We report a case of a patient with a permanent pacemaker, on rivaroxaban (NOAC) for atrial fibrillation, who developed an upper extremity deep vein thrombosis after its temporary withdrawal following a traumatic acute subdural haematoma. Physicians should be aware of the possibility of rebound hypercoagulability and venous thrombosis soon after the withdrawal of NOACs.
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Nagasayi et al. (2017) studied this question.
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