Gallbladder hemorrhage during orally administered edoxaban therapy: a case report

Abstract

BackgroundEdoxaban is an orally administered anticoagulant treatment that is used in patients with cerebral infarction, venous thrombosis, or other conditions, with a reported incidence of gastrointestinal hemorrhage at approximately 1%. We encountered the rare case of a patient who developed a gallbladder hemorrhage after the administration of edoxaban.Case presentationAn 86-year-old Japanese woman visited our gastrointestinal department due to the chief complaint of melena lasting for a week. Her medical history included hypertension and embolic cerebral infarction, and she was taking orally administered carvedilol (5 mg/day) and edoxaban (30 mg/day). Her palpebral conjunctiva was pale during a physical examination, indicating the possibility of anemia. Her blood test results confirmed severe anemia with red blood cells at 1.7 × 106/μL and hemoglobin at 4.7 g/dL. An upper gastrointestinal endoscopy revealed bile and fresh blood on the duodenal bulb and in more distal regions; hemobilia was suspected. A computed tomography scan on the ninth hospitalization day confirmed the hemobilia with a gallbladder fundus high-density signal. She was discharged on the 30th day of hospitalization with only fluid therapy and no progression of anemia. Moreover, she underwent a laparoscopic cholecystectomy 1 month after discharge, but the pathologist did not identify false aneurysms or neoplastic lesions. She has not been shown to develop anemia for 5 months after surgery.ConclusionsOur case suggests that gallbladder hemorrhage needs to be considered a possible complication for patients on direct oral anticoagulants.

Edoxaban Kullanımına Bağlı Spontan Renal Hematom: Olgu Sunumu

“…It should also be noted that; in the study of ENGAGE AF-TIMI 48, gastrointestinal bleeding was observed more frequently in edoxaban group than warfarin group in patients over 75 years of age (7). In the literature, bleeding in the gallbladder, cerebral hemorrhage, spontaneous hemopericardium, hematoma in the tympanic membrane have been reported in patients using edoxaban (8)(9)(10)(11).…”

Successful laparoscopic cholecystectomy for gallbladder hemorrhage from a Dieulafoy lesion in a patient on hemodialysis: a case report

“…Gallbladder hemorrhage is a rare entity and is most commonly associated with gallstones, acute cholecystitis, and use of antiplatelet or anticoagulants [ 6 – 8 ]. In this case, there was no obvious evidence of gallstones or neoplastic lesions, oral anticoagulant medication, or episodes of trauma.…”

Unusual gallbladder disease: spontaneous gallbladder haematoma

“…Reported risk factors for spontaneous bleeding include atherosclerosis or aneurysm, biliary malignancy, renal failure, cirrhosis, and coagulopathy, or anticoagulant medication. [1][2][3] Moreover, abdominal blunt trauma can lead to gallbladder injury and cause gallbladder bleeding. 3 Clinical manifestations of gallbladder haematoma similarly represent acute gallbladder disease.…”

“…3 Clinical manifestations of gallbladder haematoma similarly represent acute gallbladder disease. 2 Upper abdominal pain is frequent due to distension of the gallbladder, and melena or haematemesis may also be present. In cases of cholecystitis, fever may develop, and laboratory study will demonstrate inflammation.…”

“…3 Ultrasonography may reveal a blood clot in the lumen with wall thickening and fluid accumulation around the gallbladder. 2 In the CT scan, hyperdense blood and bile shadow with or without fluid level may be suspicious of gallbladder haematoma. Extravasation of contrast material into the lumen of the gallbladder during the arterial phase of contrast-enhanced CT is related to active bleeding.…”