Use of rivaroxaban in an elderly patient with intermediate-low early mortality risk due to pulmonary embolism: a case report

Abstract

Introduction: Pulmonary embolism remains one of the leading causes of cardiovascular mortality. The standard treatment for pulmonary embolism is anticoagulant therapy using low molecular weight heparin, fondaparinux and a vitamin K antagonist, but a recent clinical trial showed that rivaroxaban, an oral factor Xa inhibitor, was as effective as standard therapy for the initial and long-term treatment of pulmonary embolism and had less bleeding complications.

Case presentation: The present report describes the case of an 80-year-old white man with an intermediate to low early mortality risk of pulmonary embolism. He was successfully treated with rivaroxaban (administered orally as monotherapy), demonstrating rapid benefit without any adverse events.

Conclusion: Rivaroxaban, particularly in the acute phase of pulmonary embolism, may be considered an effective and safe therapeutic choice even in elderly patients, a population less represented in clinical trials.

Fig. 1

Electrocardiogram on admission and previous electrocardiogram without pathological features. a Electrocardiogram on admission: sinus rhythm with inversion of T waves in anterior and lateral leads. b Previous electrocardiogram without pathological features

Fig. 2

Computed tomographic pulmonary angiography on admission: multiple filling defects within the pulmonary trunk and the right pulmonary artery. Left pulmonary artery presents similar features. These computed tomography findings are suggestive of pulmonary thromboembolism (Miller index >17)

Fig. 3

Computed tomographic pulmonary angiography at the 7-day follow-up: partial reperfusion of lower lobe pulmonary arteries. The other computed tomography findings appear unchanged