{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,8,2]],"date-time":"2025-08-02T19:06:37Z","timestamp":1754161597883,"version":"3.41.2"},"reference-count":32,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2025,7,29]],"date-time":"2025-07-29T00:00:00Z","timestamp":1753747200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Med."],"abstract":"<jats:sec><jats:title>Introduction<\/jats:title><jats:p>Rivaroxaban, a novel oral anticoagulant, is widely used in patients with non-valvular atrial fibrillation. Bleeding events during rivaroxaban therapy most commonly include gastrointestinal bleeding and intracranial hemorrhage, while spontaneous hemothorax is exceedingly rare. We report a case of spontaneous hemothorax occurring during rivaroxaban administration.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>We report the case of a patient presenting primarily with dyspnea. The patient had been on long-term oral rivaroxaban for atrial fibrillation. Physical examination upon admission revealed diminished breath sounds in the left lung. Computed tomography imaging demonstrated a large left-sided pleural effusion with adjacent pulmonary atelectasis. Laboratory tests indicated significant coagulation abnormalities. After admission, the patient underwent therapeutic thoracentesis and chest tube placement, with bloody pleural fluid observed in the drainage. Due to the marked coagulation abnormalities on admission, the patient received fresh frozen plasma transfusion. Further history-taking revealed recent use of oral fluconazole. A review of the literature suggested that the spontaneous hemothorax might be associated with the concurrent use of rivaroxaban and fluconazole.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Following treatment, a follow-up computed tomography scan 3\u202fmonths later showed no evidence of recurrent hemothorax.<\/jats:p><\/jats:sec><jats:sec><jats:title>Discussion<\/jats:title><jats:p>Concomitant administration of rivaroxaban and fluconazole significantly increases the risk of bleeding events, necessitating clinician vigilance regarding potential drug\u2013drug interactions when formulating therapeutic regimens.<\/jats:p><\/jats:sec>","DOI":"10.3389\/fmed.2025.1641092","type":"journal-article","created":{"date-parts":[[2025,7,29]],"date-time":"2025-07-29T04:10:48Z","timestamp":1753762248000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Rivaroxaban-induced spontaneous hemothorax: a rare case report and literature review"],"prefix":"10.3389","volume":"12","author":[{"given":"Xiaolong","family":"Li","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Shuhao","family":"Xu","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Chunfang","family":"Zeng","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ding","family":"Han","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Xin","family":"Wang","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1965","published-online":{"date-parts":[[2025,7,29]]},"reference":[{"key":"ref1","doi-asserted-by":"publisher","first-page":"141","DOI":"10.1016\/j.jacc.2018.04.058","article-title":"Global prospective safety analysis of rivaroxaban","volume":"72","author":"Kirchhof","year":"2018","journal-title":"J Am Coll Cardiol"},{"key":"ref2","doi-asserted-by":"publisher","first-page":"936","DOI":"10.1161\/CIRCULATIONAHA.123.064556","article-title":"Development and validation of the DOAC score: a novel bleeding risk prediction tool for patients with atrial fibrillation on direct-acting oral anticoagulants","volume":"148","author":"Aggarwal","year":"2023","journal-title":"Circulation"},{"key":"ref3","doi-asserted-by":"publisher","first-page":"453","DOI":"10.1016\/j.chest.2017.10.001","article-title":"Lifetime risks, projected numbers, and adverse outcomes in Asian patients with atrial fibrillation: a report from the Taiwan nationwide AF cohort study","volume":"153","author":"Chao","year":"2018","journal-title":"Chest"},{"key":"ref4","doi-asserted-by":"publisher","first-page":"e1","DOI":"10.1161\/CIR.0000000000001193","article-title":"2023 ACC\/AHA\/ACCP\/HRS guideline for the diagnosis and management of atrial fibrillation: a report of the American College of Cardiology\/American Heart Association Joint Committee on clinical practice guidelines","volume":"149","author":"Joglar","year":"2024","journal-title":"Circulation"},{"key":"ref5","doi-asserted-by":"publisher","first-page":"228","DOI":"10.1016\/j.amjmed.2021.08.026","article-title":"Non-vitamin K antagonists versus warfarin in patients with atrial fibrillation and bioprosthetic valves: a systematic review and meta-analysis","volume":"135","author":"Cardoso","year":"2022","journal-title":"Am J Med"},{"key":"ref6","doi-asserted-by":"publisher","first-page":"1183","DOI":"10.1080\/03007995.2023.2247988","article-title":"Comparative outcomes associated with rivaroxaban versus warfarin use in elderly patients with atrial fibrillation or acute venous thromboembolism managed in the United States: a systematic review of observational studies","volume":"39","author":"Baker","year":"2023","journal-title":"Curr Med Res Opin"},{"key":"ref7","doi-asserted-by":"publisher","first-page":"10760296231178546","DOI":"10.1177\/10760296231178546","article-title":"Activated partial thromboplastin time or prothrombin time prolongation during rivaroxaban administration: clinical risk factors and outcomes analysis","volume":"29","author":"Yuan","year":"2023","journal-title":"Clin Appl Thromb Hemost"},{"key":"ref8","doi-asserted-by":"publisher","first-page":"2723","DOI":"10.1038\/s41401-022-00892-9","article-title":"Population pharmacokinetic and pharmacodynamic analysis of rivaroxaban in Chinese patients with non-valvular atrial fibrillation","volume":"43","author":"Liu","year":"2022","journal-title":"Acta Pharmacol Sin"},{"key":"ref9","doi-asserted-by":"publisher","first-page":"154","DOI":"10.1160\/TH14-02-0161","article-title":"Influence of dabigatran and rivaroxaban on routine coagulation assays. 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