A 65-Year-Old Man with Bilateral Adrenal Hemorrhage Following Prophylaxis for Postoperative Deep Vein Thrombosis with Rivaroxaban

02 September 2023: Articles

Unusual clinical course, Challenging differential diagnosis

Safa Al-Rawi ^E* , Mustafa Seidahmed ^A , Saeed Saleh Emam ^D , Eman S. Othman ^D

DOI: 10.12659/AJCR.939816

Am J Case Rep 2023; 24:e939816

Table 3. Literature review of adrenal hemorrhage due to DOACs usage.

Author (yr) [reference]	Age/Sex	Presentation	DOAC duration	DOAC agent	DOAC dosage	Reason to get VTE prophylaxis	Laterality of AH	AI secondary to the AH
Comuth (2017) []¹³	63/Female	Abdominal pain	5 months	Rivaroxaban	20 mg daily	APLS	Bilateral	+
Sanford (2019) []²⁷	42/Male	Acute onset severe right flank pain	4 weeks	Apixaban	Not reported	APLS	Unilateral	–
Ly (2019) []²²	61/Male	Nausea and vomiting	14 days	Rivaroxaban	10 mg daily	Knee surgery	Unilateral	–
Alidoost (2019) []⁸	68/Female	Severe acute onset abdominal pain	14 days	Rivaroxaban	10 mg daily	Knee surgery	Bilateral	+
Arosemena (2020) []²⁶	46/Male	Syncopal episode	Few months	Rivaroxaban	Not reported	APLS	Bilateral	+
Sheklabadi (2022) []¹⁴	35/Female	Nausea and vomiting and buccal hyperpigmentation	1 year	Apixaban	2.5 mg twice a day	IJVT	Unilateral	+
Sheklabadi (2022) []¹⁴	89/Female	Fatigue and loss of appetite	10 days	Rivaroxaban	10 mg daily	Femur surgery	Bilateral	+
Best (2013) []²⁴	75/Female	Shortness of breath and fever	9 days	Dabigatran	150 mg daily	Hip surgery	Bilateral	+
Elhassan (2022) []²⁸	44/Female	Asymptomatic	Few days	Rivaroxaban	Not reported	APLS	Bilateral	+
Current case (2022)	65/Male	Nausea and severe acute onset abdominal pain	10 days	Rivaroxaban	10 mg daily	Knee surgery	Bilateral	+
APLS – antiphospholipid syndrome; IJVT – internal jugular vein thrombosis; AH – adrenal hemorrhage; AI – adrenal insufficiency; DOAC – direct oral anticoagulant; VTE – venous thromboembolism.