Spontaneus splenic rupture in a patient treated with rivaroxaban

Rivaroxaban is a direct competitive reversible and specific inhibitor of factor X that has gained increasing popularity for stroke prevention in nonvalvular atrial fibrillation. We report the case of a 67-year-old man taking rivaroxaban 15 mg once daily for atrial fibrillation, who presented to the emergency department with acute abdominal pain. He was diagnosed of spontaneus splenic rupture with hemorrhagic shock. Despite treatment with packed red blood cells, fresh frozen plasma, and prothrombin complex concentrates, the patient's hemorrhagic shock persisted during 12 hours until splenectomy. Two days later, the patient developed multiorgan dysfunction due to colic ischemia requiring a colectomy. We describe a rare case of spontaneus splenic rupture that demonstrates the potential for serious bleeding from rivaroxaban toxicity.