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Rivaroxaban-Associated Bullous Pemphigoid in a Patient With Atrial Fibrillation.

ABSTRACT: Rivaroxaban is commonly used for prevention of thromboembolic diseases in patients with atrial fibrillation. We report a case of an 86-year-old man with hypertension, chronic kidney disease, type 2 diabetes mellitus, dyslipidemia, and atrial fibrillation who developed bullous eruptions 1 week after a rivaroxaban dose increase. He was subsequently hospitalized, and direct immunofluorescence confirmed bullous pemphigoid (BP). After switching to apixaban, the patient's skin eruptions stabilized and improved. This is the first reported case of immunofluorescence-confirmed BP associated with rivaroxaban use. Prompt discontinuation of rivaroxaban and a switch to other anticoagulants is important for patients with suspected drug-associated BP.

SUBMITTER: Liang JC

PROVIDER: S-EPMC8636228 | biostudies-literature | 2021 Oct

REPOSITORIES: biostudies-literature

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Rivaroxaban-Associated Bullous Pemphigoid in a Patient With Atrial Fibrillation.

Liang Jiaming Calvin JC Raman Karanvir K Chan Siu Him SH Tashakkor A Yashar AY

CJC open 20210612 10

Rivaroxaban is commonly used for prevention of thromboembolic diseases in patients with atrial fibrillation. We report a case of an 86-year-old man with hypertension, chronic kidney disease, type 2 diabetes mellitus, dyslipidemia, and atrial fibrillation who developed bullous eruptions 1 week after a rivaroxaban dose increase. He was subsequently hospitalized, and direct immunofluorescence confirmed bullous pemphigoid (BP). After switching to apixaban, the patient's skin eruptions stabilized and ...[more]

PMID: 34888514

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Project description:BackgroundBullous pemphigoid (BP) is the most common autoimmune blistering disease in the West. Oral steroids are the standard treatment.This is an update of the review published in 2005.ObjectivesTo assess treatments for bullous pemphigoid.Search strategyIn August 2010 we updated our searches of the Cochrane Skin Group Specialised Register, the Cochrane Central Register of Controlled Trials (Clinical Trials), MEDLINE, EMBASE, and the Ongoing Trials registers.Selection criteriaRandomised controlled trials of treatments for participants with immunofluorescence-confirmed bullous pemphigoid.Data collection and analysisAt least two authors evaluated the studies for the inclusion criteria, and extracted data independently.Main resultsWe included 10 randomised controlled trials (with a total of 1049 participants) of moderate to high risk of bias. All studies involved different comparisons, none had a placebo group. In 1 trial plasma exchange plus prednisone gave significantly better disease control at 1 month (0.3 mg/kg: RR 18.78, 95% CI 1.20 to 293.70) than prednisone alone (1.0 mg/kg: RR 1.79, 95% CI 1.11 to 2.90), while another trial showed no difference in disease control at 6 months.No differences in disease control were seen for different doses or formulations of prednisolone (one trial each), for azathioprine plus prednisone compared with prednisone alone (one trial), for prednisolone plus azathioprine compared with prednisolone plus plasma exchange (one trial), for prednisolone plus mycophenolate mofetil or plus azathioprine (one trial), for tetracycline plus nicotinamide compared with prednisolone (one trial). Chinese traditional medicine plus prednisone was not effective in one trial.There were no significant differences in healing in a comparison of a standard regimen of topical steroids (clobetasol) with a milder regimen (RR 1.00, 95% 0.97 to 1.03) in one trial. In another trial, clobetasol showed significantly more disease control than oral prednisolone in people with extensive and moderate disease (RR 1.09, 95% CI 1.02 to 1.17), with significantly reduced mortality and adverse events (RR 1.06, 95% CI 1.00 to 1.12).Authors' conclusionsVery potent topical steroids are effective and safe treatments for BP, but their use in extensive disease may be limited by side-effects and practical factors. Milder regimens (using lower doses of steroids) are safe and effective in moderate BP. Starting doses of prednisolone greater than 0.75 mg/kg/day do not give additional benefit, lower doses may be adequate to control disease and reduce the incidence and severity of adverse reactions. The effectiveness of adding plasma exchange, azathioprine or mycophenolate mofetil to corticosteroids, and combination treatment with tetracycline and nicotinamide needs further investigation.

Dataset Information

Rivaroxaban-Associated Bullous Pemphigoid in a Patient With Atrial Fibrillation.

Publications

Rivaroxaban-Associated Bullous Pemphigoid in a Patient With Atrial Fibrillation.

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