From deep vein thrombosis to the risk of angioedema: Allergy to the anticoagulant, direct factor Xa inhibitor (Rivaroxaban): A case report

Background : Direct oral anticoagulants represent one of the most significant therapeutic innovations of recent decades, having demonstrated their efficacy in managing thromboembolic events. However, allergic reactions to this class of medications, though rare, remain severe and life-threatening. The pathophysiological mechanisms remain poorly understood, and the diagnosis is primarily clinical. Management must be swift and multidisciplinary, highlighting the importance of rigorous use with clearly defined indications. Case presentation: We report the case of a 65-year-old female patient presenting with chest pain. Coronary angiography revealed significant lesions warranting medical treatment. Following the onset of pain in the right lower limb, a Doppler ultrasound of the lower limb was performed, revealing deep vein thrombosis. The patient was started on a direct Factor Xa inhibitor, which led to the development of macroglossia and difficulty swallowing after its initiation. The treatment involved replacing the direct Factor Xa inhibitor with acenocoumarol, combined with antibiotic therapy and corticosteroid treatment. Conclusion: Drug reactions to direct Factor Xa inhibitors are a rare but potentially severe side effect that can be life-threatening. This underscores the importance of appropriate use and prompt, multidisciplinary management in the event of an adverse reaction.