Non-Hemorrhage-Related Adverse Effects of Rivaroxaban

The document from 2017 reviewed non-hemorrhage-related adverse effects of rivaroxaban, noting that while bleeding is a well-known side effect, others such as liver injury, hypersensitivity reactions, leukocytoclastic vasculitis, and hair loss are less recognized. Liver injury was seen in 2.33% of patients in phase III studies, but a larger review of 29 trials with 152,116 patients showed no increased risk of liver injury. Hypersensitivity reactions occurred at a rate of 0.1-1% in the ROCKET-AF study, and there were two reported cases of leukocytoclastic vasculitis. Hair loss was reported by 9 out of 730 patients in one study, with an average onset of 68 days after starting rivaroxaban. A specific case of a 26-year-old woman showed hair loss after three months of treatment, which resolved upon discontinuation of the drug. The suspected mechanism for hair loss is telogen effluvium. Clinicians are encouraged to monitor for these rare adverse reactions and to report any unexpected clinical responses.