Clinical Effectiveness of Rivaroxaban in Patients With Idiopathic Pulmonary Fibrosis and Thrombosis of the Right Ventricle
Purpose of the study. To study effectiveness of rivaroxaban therapy, dynamics of renal function and cytokine status in a patient with idiopathic pulmonary fibrosis and right ventricular thrombosis. Material and methods. A clinical case of patient B., 49, suffering from slowly progressing idiopathic pulmonary fibrosis (IPF) complicated by chronic respiratory failure, secondary pulmonary arterial hypertension, pulmonary heart and right ventricular thrombosis, is analyzed. Laboratory (determination of creatinine, cystatin C, TNF-α and IL-10) and instrumental (echocardiography and ultrasound scanning of carotid arteries) examinations were performed initially and in the dynamics of treatment with the combination of rivaroxaban and acetylsalicylic acid (ASA). Throughout the follow-up period, the patient took rivaroxaban 20 mg, ASA 100 mg, lisinopril 5 mg, bisoprolol 2.5 mg per day and oxygen therapy on an outpatient basis. Results. Combination therapy of rivaroxaban 20 mg and acetylsalicylic acid 100 mg per day led to dissolution of the thrombus in this patient. In the dynamics of the observation, a decrease of cystatin C (1.10 mg/L vs. 1.13 mg/L) and an increase (72 ml/min versus 66,7 ml/min) of the estimated glomerular filtration rate were noted. The concentration IL-10 concentration increased (initially 8.904 pg/ml versus 16.216 pg/ml in dynamics, respectively), TNF-α level decreased (initially 3.750 pg/ml versus 1.957 pg/ml in dynamics, respectively). During the treatment, a decrease in the right ventricular cavity (3.2 cm vs. 3.5 cm), pulmonary artery diameter (3.1 cm vs. 3.5 cm), pulmonary artery pressure (63 mm Hg vs. 74 mm Hg) and an increase in the size of the systolic excursion of the tricuspid valve ring (2.1 cm vs. 2.0 cm) was found compared with the baseline data. Conclusion. Use of rivaroxaban at a dose of 20 mg and acetylsalicylic acid of 100 mg per day in a patient with right ventricular thrombosis as a result of idiopathic pulmonary fibrosis complicated by chronic heart failure is effective and safe for the prevention of systemic embolism of cerebral stroke. The combination of rivaroxaban and low doses of acetylsalicylic acid in the traditional therapy has a positive cardio and nephroprotective effect.