Direct oral anticoagulants (DOACs or NOACs -non-vitamin K oral anticoagulants), as the name suggests, are oral anticoagulants with a direct inhibitory action either against factor X or factor II (thrombin). Pregnant women were excluded from participating in all the large trials of the DOACs and they are considered contra-indicated in pregnancy and breast feeding. We present a case of inadvertent exposure to rivaroxaban in a woman who presented at 25 weeks' gestation. The management of her pregnancy and delivery is described, and the previous published case reports are reviewed with a discussion about the use of DOACs in woman of childbearing age.
BatesSMGreerIAMiddeldorpS. VTE, thrombophilia, antithrombotic therapy, and pregnancy: Antithrombotic Therapy and Prevention of Thrombosis: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines (9th edition). Chest2012; 141: e691S–736S.
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FerreiraMBarsamSPatelJP. Heavy menstrual bleeding on rivaroxaban. Br J Haem2015; 162: 717–718.
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De CremNPeerlinckKVanasscheT. Abnormal uterine bleeding in VTE patients treated with rivaroxaban compared to vitamin K antagonists. Thromb Haemost2015; 136: 749–753.
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HuqFYTvarkovaKArafaA. Menstrual problems and contraception in women of reproductive age receiving oral anticoagulation. Contraception2011; 84: 128–132.
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CulwellKRCurtisKM. Use of contraceptive methods by women with current venous thrombosis on anticoagulant therapy: A systematic review. Contraception2009; 80: 337–345.
