Apixaban
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Spontaneous splenic haemorrhage: case report A 57-year-old woman developed spontaneous splenic haemorrhage during treatment with apixaban for provoked pulmonary embolism (PE). The woman recently started receiving oral apixaban [dosage not stated] for provoked PE. She had been discharged from an outside facility. She presented a few hours after the discharge to the emergency department in extremis (in a state of shock): unconscious, hypotensive, pale and tachycardic. On admission, her abdomen was distended. Bedside ultrasound revealed massive peritoneal fluid. Hemoperitoneum was confirmed on prompt diagnostic peritoneal aspirate. The woman underwent a massive transfusion protocol. Her initial haemoglobin was 4.2 g/dL, haematocrit was 13.4% and platelet count was 204 000/µL. Her prothrombin time was 19.5s and international normalised ratio was 2.02. She received packed red blood cells, plasma [fresh frozen plasma], prothrombin complex concentrate and calcium. Her BP, heart rate and mental status improved. CT scan showed large subcapsular splenic haematoma with active extravasation at the periphery of the spleen. Based on these findings and clinical presentation, a diagnosis of spontaneous splenic haemorrhage secondary to apixaban was made [duration of treatment to reaction onset not stated]. She was emergently admitted to the interventional radiology suit and splenic artery embolisation was performed and an inferior vena cava filter was placed. Subsequently, she developed acute respiratory distress syndrome and persistent low urine output with hypotension in spite of resuscitation. Thus, she was shifted to the operating room and splenectomy with abdominal washout was performed. Thereafter, her condition improved, and 12 days later she was discharged . Janke A, et al. Spontaneous splenic hemorrhage in a patient on apixiban. American Journal of Emergency Medicine 38: 1044e1-1044e2, No. 5, May 2020. Available from: 803497562 URL: http://doi.org/10.1016/j.ajem.2019.12.006
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Reactions 22 Aug 2020 No. 1818
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