Amiodarone/apixaban interaction
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Spontaneous retroperitoneal haemorrhage: case report An 86-year-old woman developed spontaneous retroperitoneal haemorrhage (SRH) following concomitant treatment of apixaban with amiodarone for atrial fibrillation. The woman presented to an emergency department (ED) with acute onset severe right hip pain that worsened with movement. Her medical history included total right hip replacement two years prior, atrial fibrillation and implantation of pacemaker. Additionally, she had been receiving treatment with apixaban 5mg two times/day [not all dosages stated; routes not stated] from last 2 years for atrial fibrillation and was also receiving amiodarone concomitantly. At the time of the ED presentation, she was mildly hypertensive. Subseuqent musculoskeletal examination showed intact right hip range of motion with pain on hip flexion. Palpation of the right anterior proximal thigh elicited pain that radiated to the hip without bony tenderness, swelling or ecchymosis. Laboratory examination showed a platelet count of 290 K/µL, haemoglobin of 11.7 g/dL, leukocyte count of 13.4 K/µL (leukocytosis) without bandemia, hematocrit of 34.3% and mildly elevated creatinine (1.02 mg/dL). Then, a CT scan of the right hip showed a 5 x 3 x 10cm retroperitoneal haemorrhage involving the right iliacus muscle. Based on the CT scan, she was diagnosed with SRH secondary to amiodarone and apixaban [duration of treatment to reaction onset not stated]. Later, she was transferred to an intensive care unit. The woman’s apixaban treatment was discontinued. During the hospitalisation, her haemoglobin slightly decreased from 11.7 g/dL to 10.5 g/dL, but on the second day of admission, the haemoglobin level stabilised and she was discharged from the hospital without any invasive procedures. The physician advised her to discontinue apixaban, as she had normal sinus rhythm and pacemaker. Khan A, et al. Pain in the hip: Spontaneous retroperitoneal hemorrhage in an elderly patient on apixaban. American Journal of Emergency Medicine 38: 1046e1-1046e3, No. 803499127 5, May 2020. Available from: URL: http://doi.org/10.1016/j.ajem.2019.12.049
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