Work

Rivaroxaban use during vitamin K1 therapy for rodenticide poisoning

Year: 2025

Type: article

Abstract: Background Management of severe anticoagulant rodenticide poisoning relies mainly on vitamin K 1 (VK 1 ) therapy, which often requires prolonged administration when long-acting anticoagulant rodenticides (LAARs) are involved. Key Clinical Question Can a direct oral anticoagulant (DOAC) be safely reintroduced in a patient at high risk of thrombosis recurrence whose LAAR poisoning is being managed with prolonged VK 1 therapy? Clinical Approach We report the case of a patient receiving rivaroxaban for recurrent thrombosis who ingested massive amounts of brodifacoum, difenacoum, and difethialone over the course of one month. He developed severe vitamin K–dependent coagulopathy (INR>26) with hematuria, necessitating discontinuation of rivaroxaban and initiation of intravenous, followed by long-term oral, VK 1 therapy. Rivaroxaban was successfully reintroduced under close clinical and laboratory monitoring after several days of ongoing oral VK 1 therapy. Conclusions This case demonstrates the feasibility of resuming DOAC therapy during VK 1 treatment after LAARs poisoning.

Source: Research and Practice in Thrombosis and Haemostasis

DOI: 10.1016/j.rpth.2025.103273