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Heroin Addiction and Related Clinical Problems: 2017, 19, N1 (pages: 41 - 44)

Directly Observed Rivaroxaban Therapy for Recurrent Venous Thromboembolism Integrated into Methadone Maintenance. A Case Report.

Weichert I.

Summary: Background: Intravenous drug use is associated with venous thromboembolism and poor compliance with medication. This puts patients at risk of recurrence of a potentially life-threatening disease and creates a significant challenge for clinicians. In the same patient group, adherence to treatment for HIV, hepatitis c, and tuberculosis improves when combined with methadone maintenance and in directly observed therapy but this approach is generally not employed in the management of other conditions. Case Report: A drug user, with a history of thrombophilia and repeated thromboembolism, presented with a recurrence of pulmonary embolism after not adhering to anticoagulation. Rivaroxaban was restarted in directly observed therapy, combined with the already established methadone therapy. This led to compliance with anticoagulation without affecting the stabilisation treatment. Conclusions: This strategy, mainly used to improve compliance in the management of conditions that pose a particular risk to public health, should be considered to help drug users adhere to therapy for venous thromboembolism and indeed other medical conditions. This is the first published case where anticoagulation has been successfully integrated into directly observed methadone maintenance.