Apixaban
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Lack of efficacy: case report A 47-year-old man exhibited inefficacy of apixaban while receiving apixaban for prevention of thrombosis recurrence. The man, who was diagnosed with femoral deep vein thrombosis complicated by a pulmonary embolism, started receiving anticoagulant therapy with oral apixaban 5mg twice daily (in the morning and evening). His apixaban was continued to prevent recurrence of thrombosis. Two months after initiation of apixaban, he presented to the emergency department with sudden onset of intense lumbar and abdominal pain. Physical examination showed a livedo reticularis of the lumbar vertebrae. An abdominal-pelvic CT-scan revealed bilateral adrenal haematomas. Following further investigations, an inflammatory syndrome was suspected. The serum apixaban level was 155 ng/mL, suggesting good compliance. The man’s apixaban was changed to enoxaparin sodium. Simultaneously, he was diagnosed with bilateral adrenal haemorrhage and primitive catastrophic antiphospholipid syndrome. The bilateral adrenal haematomas were considered to be a complication of antiphospholipid syndrome. In the context of bilateral adrenal haematomas and the underlying antiphospholipid syndrome, it was determined that thrombosis of the adrenal veins might have occurred, which suggested inefficacy of apixaban. After 2 days, he presented due to hypotensive discomfort with cold extremities, tachycardia and increased abdominal pain, along with hypoaldosteronism (secondary to the underlying anti-phospholipid syndrome). He was treated with hydrocortisone and heparin, which were later switched to warfarin and fludrocortisone, respectively. He remained asymptomatic at a follow-up after 6 months from the acute episode without new thrombotic episode on warfarin. Lavoipierre V, et al. Bilateral adrenal hemorrhage under apixaban in primary antiphospholipid syndrome. Revue de Medecine Interne 41: 489-492, No. 7, Jul 2020. Available from: URL: http://doi.org/10.1016/j.revmed.2019.09.003 [French; summarised from a translation] 803506426
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Reactions 10 Oct 2020 No. 1825
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