Treatment of Rivaroxaban Associated Orbital Hemorrhage

An elderly man awoke with severe pain and bruising of right periocular area. He had taken his usual rivaroxaban the nght before and reported no trauma. CT scanning showed a an orbital hemorrhage. HIs ocular pressure was in the mid thirties and did not respond to glaucoma medications or subsequent canthotomy.Treatment with an antagonist to rivaroxaban was carried out after transfer to my institution. Discussion of the mechanism of rivaroxaban's efficacy and the use of an antagonist drug that is usually used to reverse cardiac -related anticoagulation will be discussed .