CLINICAL COMMUNICATION TO THE EDITOR
Venous Gangrene and Intravascular Coagulation and Fibrinolysis in a Patient Treated with Rivaroxaban To the Editor: A 67-year-old woman presented with new bilateral leg swelling and was diagnosed with bilateral deep vein thromboses. Rivaroxaban was started at 15 mg twice daily. Ten days later, the patient experienced increased right foot swelling, pain, and cyanosis (Figure). On admission, a right leg arterial ultrasound was normal, but a compression venous duplex ultrasound revealed extensive venous thrombosis of the entire leg. Laboratory evaluation revealed new thrombocytopenia (19,000 cells/mL, reference range 150,000-450,000 cells/mL), reduced renal function (estimated glomerular filtration rate 54 mL/min/m2, reference range >60 mL/min/m2), elevated D-dimer (>20,000 ng/mL, reference range
Venous Gangrene and Intravascular Coagulation and Fibrinolysis in a Patient Treated with Rivaroxaban To the Editor: A 67-year-old woman presented with new bilateral leg swelling and was diagnosed with bilateral deep vein thromboses. Rivaroxaban was started at 15 mg twice daily. Ten days later, the patient experienced increased right foot swelling, pain, and cyanosis (Figure). On admission, a right leg arterial ultrasound was normal, but a compression venous duplex ultrasound revealed extensive venous thrombosis of the entire leg. Laboratory evaluation revealed new thrombocytopenia (19,000 cells/mL, reference range 150,000-450,000 cells/mL), reduced renal function (estimated glomerular filtration rate 54 mL/min/m2, reference range >60 mL/min/m2), elevated D-dimer (>20,000 ng/mL, reference range
