E to reverse the effects of the drug is an aspect

E to reverse the effects of the drug is an aspect that needs further research. Early studies have shown that prothrombin complex concentrate may be useful in reversing the effects of rivaroxaban [7]. Other possible measures include the use of recombinant Factor 3-Iodo-2-naphthonitrile VIIa to reduce bleeding or the use of activated charcoal to reduce absorption in cases of overdose.Conclusion This case outlines clearly, and for the first time in the literature, the rare but serious risk of hemorrhage associated with rivaroxaban. Prescribing orthopedic specialists should take care in providing information regarding the risk of bleeding to patients commencing the medication and inform these patients that urgent medical attention is needed if such a side effect occurs. The efficacy and ease of use associated with this new anticoagulant means that its use is likely to increase across multiple medical specialties, making this case important for a wide range of medical professionals. This case also outlines how such a side effect is managed effectively and that immediate discontinuation of rivaroxaban is a vital step in dealing with hemorrhage. This case has not altered the use of rivaroxaban in our health facility but has drawn attention to a serious side effect of the drug. Consent Written informed consent was obtained from the patient for publication of this case report and any accompanying images. A copy of the written consent is available for review by the Editor-in-Chief of this journal.Abbreviations BP: blood pressure; Hb: hemoglobin; PR: per rectum; PRBCs: packed red blood cells; THA: total hip arthroplasty. Competing interests The authors declare that they have no competing interests and received no funding for the 1-(5-(Aminomethyl)-2-nitrophenyl)ethanol production of this case report. Authors' contributions MB drafted and critically revised the manuscript. MM PubMed ID:https://www.ncbi.nlm.nih.gov/pubmed/14704548 contributed to drafting the article and collected data. MM contributed to drafting and critically revised the manuscript. EMcD contributed to the drafting of the manuscript. All authors read and approved the final manuscript. Received: 24 November 2011 Accepted: 14 May 2012 Published: 14 MayReferences 1. Eriksson BI, Borris LC, Friedman RJ, Haas S, Huisman MV, Kakkar AK, Bandel TJ, Beckmann H, Muehlhofer E, Misselwitz F, Geerts W, RECORD1 Study Group: Rivaroxaban versus enoxaparin for thromboprophylaxis after hip arthroplasty. N Engl J Med 2008, 358(26):2765?775. 2. Kakkar AK, Brenner B, Dahl OE, Eriksson BI, Mouret P, Muntz J, Soglian AG, Pap AF, Misselwitz F, Haas S, RECORD2 Investigators: Extended duration rivaroxaban versus short-term enoxaparin for the prevention of venous thromboembolism after total hip arthroplasty: a double blind randomised controlled trial. Lancet 2008, 372(9632):31?9. 3. Lassen MR, Ageno W, Borris LC, Lieberman JR, Rosencher N, Bandel TJ, PubMed ID:https://www.ncbi.nlm.nih.gov/pubmed/14704548 Misselwitz F, Turpie AG, RECORD3 Investigators: Rivaroxaban versus enoxaparin for thromboprophylaxis after total knee arthroplasty. N Engl J Med 2008, 358(26):2776?786. 4. Turpie AG, Lassen MR, Davidson BL, Bauer KA, Gent M, Kwong LM, Cushner FD, Lotke PA, Berkowitz SD, Bandel TJ, Benson A, Misselwitz F, Fisher WD, RECORD4 Investigators: Rivaroxaban versus enoxaparin for thromboprophylaxis after total knee arthroplasty (RECORD4): a randomised trial. Lancet 2009, 373(9676):1673?680. 5. EINSTEIN Investigators, Bauersachs R, Berkowitz SD, Brenner B, Buller HR, Decousus H, Gallus AS, Lensing AW, Misselwitz F, Prins MH, Raskob GE, Segers A, Verhamme P, Wells P, Agnelli G, Bounameaux H.