Edoxaban
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Gallbladder haemorrhage: case report An 86-year-old woman developed gallbladder haemorrhage during treatment with edoxaban for embolic cerebral infarction. The woman presented with a 1-week onset of melaena. Prior to the presentation, she had received lafutidine [Protecadin], but malaena persisted. She had been receiving oral edoxaban 30 mg/day for further infarction prevention in the setting of embolic cerebral infarction and carvedilol for hypertension. On presentation, the paleness of palpebral conjunctiva suggested anaemia, which was confirmed by blood investigations. Her blood urea nitrogen and creatine ratio of 52.1 mg/dL versus 1.29 mg/dL suggested dissociation. Therefore, an upper gastrointestinal haemorrhage was suspected. An upper endoscopy showed fresh blood and bile at her duodenal bulb and distal regions. The woman received transfusion for anaemia caused by haemobilia. A CT scan on hospital day 9 revealed persistent Hb reductions revealed a high-density image in her gallbladder fundus. A diagnosis of gallbladder haemorrhage secondary to edoxaban was made [duration of treatment to reaction onset not stated]. Therefore, edoxaban was discontinued. On day 30, an upper gastrointestinal endoscopy showed no bleeding, and she was discharged home. The woman was re-initiated on edoxaban. A magnetic resonance cholangiopancreatography performed 2 weeks post-discharge confirmed the absence of biliary stenosis or pancreaticobiliary maljunction. After one month of discharge, a laparoscopic cholecystectomy was done. Post surgical findings revealed mild chronic cholecystitis, without false aneurysms or tumorous lesions. At the time of report, 5 months after the surgery, she did not have anaemia, and was regularly followed-up in an out-patient basis. Itagaki H, et al. Gallbladder hemorrhage during orally administered edoxaban therapy: A case report. Journal of Medical Case Reports 13: 383, No. 1, 2019. Available from: URL: http://doi.org/10.1186/s13256-019-2328-9 803445969
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Reactions 18 Jan 2020 No. 1787
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