Rivaroxaban-Associated Bullous Pemphigoid in a Patient With Atrial Fibrillation.

Rivaroxaban is commonly used for prevention of thromboembolic diseases in patients with atrial fibrillation. We report a case of an 86-year-old man with hypertension, chronic kidney disease, type 2 diabetes mellitus, dyslipidemia, and atrial fibrillation who developed bullous eruptions 1 week after a rivaroxaban dose increase. He was subsequently hospitalized, and direct immunofluorescence confirmed bullous pemphigoid (BP). After switching to apixaban, the patient's skin eruptions stabilized and improved. This is the first reported case of immunofluorescence-confirmed BP associated with rivaroxaban use. Prompt discontinuation of rivaroxaban and a switch to other anticoagulants is important for patients with suspected drug-associated BP.

Le rivaroxaban est couramment utilisé pour la prévention des maladies thromboemboliques chez les patients atteints de fibrillation auriculaire. Nous rapportons le cas d'un homme de 86 ans atteint d'hypertension, de néphropathie chronique, de diabète de type 2, de dyslipidémie et de fibrillation auriculaire, qui a présenté des éruptions bulleuses une semaine après l'augmentation de sa dose de rivaroxaban. Il a par la suite été hospitalisé, et une analyse par immunofluorescence directe a permis de confirmer le diagnostic de pemphigoïde bulleuse. Après le passage à l'apixaban, les éruptions cutanées du patient se sont stabilisées et atténuées. Il s'agit du premier cas rapporté de pemphigoïde bulleuse confirmée par immunofluorescence associé à l'utilisation du rivaroxaban. Chez les patients présentant une pemphigoïde bulleuse possiblement associée au rivaroxaban, il est important d'arrêter rapidement l'administration du médicament et de le remplacer par d'autres anticoagulants.

Ankle-brachial index as an indicator of arterial stiffness in patients without peripheral artery disease.

We tested the hypothesis that the Ankle-Brachial Index (ABI) in patients without peripheral arterial disease ([PAD] ABI > 1.0) is an indicator of arterial stiffness. Fifty-five patients had measurement of carotid pulse wave contour, pulse wave velocity (PWV), and ABI. Vascular stiffness as assessed by augmentation index (AIx) showed a significant (P = .002) inverse correlation with ABI. Dichotomizing ABI into groups above and below the median showed that persons with a lower ABI, >1.0 to 1.5 (n = 27) had a significantly (P < .01) higher AIx than those with a higher ABI > 1.5 (n = 28). In contrast, vascular stiffness assessed by brachial-ankle or carotid femoral PWV did not correlate with ABI. In summary, ABI is an indicator of arterial stiffness assessed by AIx. Vascular changes detected by AIx are not the same as those detected by PWV. Assessment of ABI may have utility in cardiovascular risk assessment in patients without PAD.

Twenty-year prevalence of diabetes mellitus and hypertension in patients receiving shock-wave lithotripsy for urolithiasis.

OBJECTIVES: To compare the prevalence of hypertension and diabetes mellitus (DM) in patients treated with an unmodified HM-3 lithotripter (USWL) and a second-generation modified HM-3 lithotripter (MSWL) 20 years ago at our Centre with that in the provincial population. To determine whether the type of lithotripter was differentially associated with the development of these sequelae. PATIENTS AND METHODS: Retrospective review of 727 patients at Vancouver General Hospital who underwent shock-wave lithotripsy (SWL) between 1985 and 1989. Our study group was compared with Statistics Canada data describing the provincial prevalence of these diseases. Multivariate analysis was performed. RESULTS: The response rate was 37.3%. There was a greater proportion of overweight and obese individuals in the study group compared with the provincial average. In univariate analysis, lithotripsy with an unmodified HM-3 (USWL) was associated with a higher rate of DM than the provincial rate, whereas lithotripsy with the modified HM-3 (MSWL) was not. Hypertension was more prevalent in all lithotripsy subjects. On multivariate analysis the type of lithotripter was not associated with the development of either sequela. CONCLUSIONS: No association between lithotripsy and the development of either DM or hypertension in a multivariate analysis Metabolic syndrome may have elevated the prevalence of DM and hypertension observed in our subjects on univariate analysis, which is in keeping with the fact that our study population had statistically higher body mass indices than the provincial rate. Lithotripsy using the HM-3 was not associated with increased DM or hypertension.