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Acute liver failure after changing oral anticoagulant from apixaban to rivaroxaban
  1. Vikram Rao1 and
  2. Anna Munasinghe2
  1. 1Department of General Medicine, Monash Medical Centre, Clayton, Melbourne, Victoria, Australia
  2. 2Department of Nephrology, Monash Medical Centre, Clayton, Melbourne, Victoria, Australia
  1. Correspondence to Dr Vikram Rao; vikramaditya.rao{at}


Rivaroxaban is a commonly used anticoagulant agent for treatment and prevention of thromboembolism. There are case reports demonstrating an association between its use and drug-induced liver injury. However, this has not been reported in a patient who previously tolerated apixaban. An 88-year-old man presented to hospital with worsening lethargy, jaundice and vomiting. He had severely elevated liver transaminases, an abnormal coagulation profile and elevated bilirubin in keeping with acute liver injury. This is in the context of having had his anticoagulation medication switched from apixaban to rivaroxaban 2 weeks prior. The patient recovered well after cessation of rivaroxaban, suggesting that it was the likely offending agent. The mechanism of rivaroxaban-induced liver injury remains to be investigated. Drug-induced liver injury should be discussed and monitored for as a potential adverse reaction when commencing rivaroxaban, even if a patient has previously tolerated a drug of the same class.

  • gastroenterology
  • liver disease
  • haematology (drugs and medicines)
  • contraindications and precautions

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  • Contributors VR is the main author of this case report and contributed to conception, planning, composition of the case report and also involved in reviewing the literature and finalising the manuscript. AM contributed to supervising and planning the composition of the case report and was also involved in reviewing the literature. She was involved in supervising and finalising the manuscript.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.