Managing venous thrombosis in a pediatric patient with short bowel and congenital nephrotic syndromes: a case report emphasizing rivaroxaban level monitoring
Copyright policy )Managing venous thrombosis in a pediatric patient with short bowel and congenital nephrotic syndromes: a case report emphasizing rivaroxaban level monitoring
Direct Oral Anticoagulants (DOACs) typically exhibit a predictable pharmacokinetic and pharmacodynamic response at a fixed dose, not necessitating monitoring under standard conditions. Yet, in specific clinical scenarios that can impair it, like Congenital Nephrotic Syndrome (CNS) or Short Bowel Syndrome (SBS) due to absorption issues, anti-thrombin III (AT-III) deficiency and non-selective proteinuria, adjusting the dosage to achieve appropriate plasma concentrations could prove beneficial. We report a 3-month-old female with catheter-related jugular thrombosis affected by CNS concomitant to SBS and failure of both treatments with heparin and warfarin, that was switched to dose-adjusted pediatric rivaroxaban. Rivaroxaban was adjusted to reach peak levels between 189 and 419 ng/ml and the lower trough levels between 6 and 87 ng/ml. Increasing doses were needed due to SBS related malabsorption but a complete permeabilization of the vein was achieved without bleeding complications. The use of anti-Xa adjusted rivaroxaban could be an alternative to improve anticoagulation and secondary thromboprophylaxis in pediatric patients SBS and an option to children with CNS.
- University System of Ohio United States
- University of Cincinnati United States
- Vall d'Hebron Institute of Oncology (VHIO) Spain
- Hospital Universitario Vall d'Hebrón Spain
- Cleveland Clinic United States
DENOMINACIONES DE GRUPOS::personas::Grupos de Edad::lactante, Other subheadings::Other subheadings::Other subheadings::/drug therapy, Otros calificadores::Otros calificadores::Otros calificadores::/farmacoterapia, DISEASES::Cardiovascular Diseases::Vascular Diseases::Embolism and Thrombosis::Thrombosis::Venous Thrombosis, congenital nephrotic syndrome, NAMED GROUPS::Persons::Age Groups::Infant, short bowel syndrome, ENFERMEDADES::enfermedades de los genitales femeninos y complicaciones del embarazo::enfermedades urogenitales femeninas::enfermedades urológicas::enfermedades renales::nefrosis::síndrome nefrótico, Pediatrics, RJ1-570, direct action anticoagulants, COMPUESTOS QUÍMICOS Y DROGAS::acciones y usos químicos::acciones farmacológicas::usos terapéuticos::fármacos hematológicos::anticoagulantes, Anticoagulants (Medicina), DISEASES::Female Urogenital Diseases and Pregnancy Complications::Female Urogenital Diseases::Urologic Diseases::Kidney Diseases::Nephrosis::Nephrotic Syndrome, CHEMICALS AND DRUGS::Chemical Actions and Uses::Pharmacologic Actions::Therapeutic Uses::Hematologic Agents::Anticoagulants, Malalties congènites en els infants, Trombosi - Tractament, anticoagulation, thrombosis, Ronyons - Malalties - Tractament, ENFERMEDADES::enfermedades cardiovasculares::enfermedades vasculares::embolia y trombosis::trombosis::trombosis venosa
DENOMINACIONES DE GRUPOS::personas::Grupos de Edad::lactante, Other subheadings::Other subheadings::Other subheadings::/drug therapy, Otros calificadores::Otros calificadores::Otros calificadores::/farmacoterapia, DISEASES::Cardiovascular Diseases::Vascular Diseases::Embolism and Thrombosis::Thrombosis::Venous Thrombosis, congenital nephrotic syndrome, NAMED GROUPS::Persons::Age Groups::Infant, short bowel syndrome, ENFERMEDADES::enfermedades de los genitales femeninos y complicaciones del embarazo::enfermedades urogenitales femeninas::enfermedades urológicas::enfermedades renales::nefrosis::síndrome nefrótico, Pediatrics, RJ1-570, direct action anticoagulants, COMPUESTOS QUÍMICOS Y DROGAS::acciones y usos químicos::acciones farmacológicas::usos terapéuticos::fármacos hematológicos::anticoagulantes, Anticoagulants (Medicina), DISEASES::Female Urogenital Diseases and Pregnancy Complications::Female Urogenital Diseases::Urologic Diseases::Kidney Diseases::Nephrosis::Nephrotic Syndrome, CHEMICALS AND DRUGS::Chemical Actions and Uses::Pharmacologic Actions::Therapeutic Uses::Hematologic Agents::Anticoagulants, Malalties congènites en els infants, Trombosi - Tractament, anticoagulation, thrombosis, Ronyons - Malalties - Tractament, ENFERMEDADES::enfermedades cardiovasculares::enfermedades vasculares::embolia y trombosis::trombosis::trombosis venosa
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