Rivaroxaban triggered multifocal intratumoral hemorrhage of the cabozantinib-treated diffuse brain metastases: A case report and review of literature

Brain metastases (BMs) are the most common intracranial malignancy with poor prognosis. Patients with intracranial tumors are at greater risk for thrombotic complications and intracranial hemorrhage. Rivaroxaban is a potent oral anticoagulant with the high selectivity of direct factor Xa inhibition....

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Autores principales:	Chen Luyue, Chen E, Huang Yanlin, Tian Xinhua
Formato:	article
Lenguaje:	EN
Publicado:	De Gruyter 2021
Materias:	brain metastases rivaroxaban intratumoral hemorrhage venous thromboembolism Medicine R
Acceso en línea:	https://doaj.org/article/fc7bba1ce001477ab657802a1b2163bf
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spelling	oai:doaj.org-article:fc7bba1ce001477ab657802a1b2163bf2021-12-05T14:10:54ZRivaroxaban triggered multifocal intratumoral hemorrhage of the cabozantinib-treated diffuse brain metastases: A case report and review of literature2391-546310.1515/med-2021-0261https://doaj.org/article/fc7bba1ce001477ab657802a1b2163bf2021-04-01T00:00:00Zhttps://doi.org/10.1515/med-2021-0261https://doaj.org/toc/2391-5463Brain metastases (BMs) are the most common intracranial malignancy with poor prognosis. Patients with intracranial tumors are at greater risk for thrombotic complications and intracranial hemorrhage. Rivaroxaban is a potent oral anticoagulant with the high selectivity of direct factor Xa inhibition. The incidence and severity of rivaroxaban-triggered intratumoral hemorrhage (ITH) in patients with BMs remain unknown. A 57-year-old woman was diagnosed with multiple lung, bone, and BMs from unknown primary cancer origin, and refused any invasive procedures to confirm tumor pathology. However, this patient had a relatively favorable outcome after treating with cabozantinib, an inhibitor of multiple tyrosine kinases. The patient survived over 2 years and developed deep vein thrombosis of right lower limb. Oral rivaroxaban was prescribed, and the multifocal catastrophic ITH was encountered after 1 week. The last head computed tomography imaging revealed a rare but typical image of diffuse hemorrhagic metastases. Hemorrhagic-prone BMs, therapeutic rivaroxaban, and cabozantinib treatment increase risks to develop ITH. In this case rivaroxaban was the trigger to this terminal event. This case is a miserable lesson and keeps reminding us to stay vigilant in clinical practice even when there is a potential benefit for anticoagulation in such population.Chen LuyueChen EHuang YanlinTian XinhuaDe Gruyterarticlebrain metastasesrivaroxabanintratumoral hemorrhagevenous thromboembolismMedicineRENOpen Medicine, Vol 16, Iss 1, Pp 618-623 (2021)
institution	DOAJ
collection	DOAJ
language	EN
topic	brain metastases rivaroxaban intratumoral hemorrhage venous thromboembolism Medicine R
spellingShingle	brain metastases rivaroxaban intratumoral hemorrhage venous thromboembolism Medicine R Chen Luyue Chen E Huang Yanlin Tian Xinhua Rivaroxaban triggered multifocal intratumoral hemorrhage of the cabozantinib-treated diffuse brain metastases: A case report and review of literature
description	Brain metastases (BMs) are the most common intracranial malignancy with poor prognosis. Patients with intracranial tumors are at greater risk for thrombotic complications and intracranial hemorrhage. Rivaroxaban is a potent oral anticoagulant with the high selectivity of direct factor Xa inhibition. The incidence and severity of rivaroxaban-triggered intratumoral hemorrhage (ITH) in patients with BMs remain unknown. A 57-year-old woman was diagnosed with multiple lung, bone, and BMs from unknown primary cancer origin, and refused any invasive procedures to confirm tumor pathology. However, this patient had a relatively favorable outcome after treating with cabozantinib, an inhibitor of multiple tyrosine kinases. The patient survived over 2 years and developed deep vein thrombosis of right lower limb. Oral rivaroxaban was prescribed, and the multifocal catastrophic ITH was encountered after 1 week. The last head computed tomography imaging revealed a rare but typical image of diffuse hemorrhagic metastases. Hemorrhagic-prone BMs, therapeutic rivaroxaban, and cabozantinib treatment increase risks to develop ITH. In this case rivaroxaban was the trigger to this terminal event. This case is a miserable lesson and keeps reminding us to stay vigilant in clinical practice even when there is a potential benefit for anticoagulation in such population.
format	article
author	Chen Luyue Chen E Huang Yanlin Tian Xinhua
author_facet	Chen Luyue Chen E Huang Yanlin Tian Xinhua
author_sort	Chen Luyue
title	Rivaroxaban triggered multifocal intratumoral hemorrhage of the cabozantinib-treated diffuse brain metastases: A case report and review of literature
title_short	Rivaroxaban triggered multifocal intratumoral hemorrhage of the cabozantinib-treated diffuse brain metastases: A case report and review of literature
title_full	Rivaroxaban triggered multifocal intratumoral hemorrhage of the cabozantinib-treated diffuse brain metastases: A case report and review of literature
title_fullStr	Rivaroxaban triggered multifocal intratumoral hemorrhage of the cabozantinib-treated diffuse brain metastases: A case report and review of literature
title_full_unstemmed	Rivaroxaban triggered multifocal intratumoral hemorrhage of the cabozantinib-treated diffuse brain metastases: A case report and review of literature
title_sort	rivaroxaban triggered multifocal intratumoral hemorrhage of the cabozantinib-treated diffuse brain metastases: a case report and review of literature
publisher	De Gruyter
publishDate	2021
url	https://doaj.org/article/fc7bba1ce001477ab657802a1b2163bf
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Rivaroxaban triggered multifocal intratumoral hemorrhage of the cabozantinib-treated diffuse brain metastases: A case report and review of literature

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