Pulmonary Venous Thromboembolism in an Acutely Ill Medical Patient Receiving Rivaroxaban.

Role of prophylactic anticoagulation in acutely ill medical patients has been extensively probed with the development of guidelines which made it convenient for the physicians to adopt a particular anticoagulation regimen for thromboprophylaxis. Intermingled with the guidelines are the development of modern anticoagulants like direct factor Xa inhibitors which are being studied for their role in the prevention of venous thromboembolism (VTE) in medically ill patients and have been concluded so far with the positive note. We are going to discuss a case of a patient who was admitted in the medical ICU with hospital acquired pneumonia. As her immediate risk of VTE was low (Wells criteria), she was advised mechanical measures to prevent VTE along with continuation of rivaroxaban therapy which had already been prescribed for her avalvular atrial fibrillation. While mechanically ventilated, she developed pulmonary venous thromboembolism. It is the first case report of VTE in adequately anticoagulated patient with rivaroxaban.