Pain in the hip: Spontaneous retroperitoneal hemorrhage in an elderly patient on apixaban

Khan, Adil; Mastenbrook, Joshua; Bauler, Laura

doi:10.1016/j.ajem.2019.12.049

Cited by 10 publications

(5 citation statements)

References 23 publications

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“…Foram, no entanto, já descritos casos de HRE associados a DOAC. 18,19 Apesar de a maioria dos doentes do nosso estudo ser hipocoagulada, destes, apenas 30% apresentavam um INR ou APTT supra-terapêuticos. De facto, INR supra--terapêutico não está universalmente presente nos casos de HRE.…”

Section: Discussionunclassified

Hematoma Retroperitoneal Espontâneo: A Experiência de um Centro

Beirão

Barreira

Guimarães

2022

Gaz Med

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INTRODUÇÃO: O hematoma retroperitoneal espontâneo (HRE) é uma entidade rara e potencialmente fatal, classicamente descrita como uma complicação da terapêutica anticoagulante. Pode constituir um desafio diagnóstico, dada a heterogeneidade das manifestações clínicas. O objetivo deste estudo é caracterizar uma população de doentes com HRE e identificar fatores preditores de mortalidade.MÉTODOS: Estudo retrospetivo incluindo todos os doentes admitidos num hospital distrital num período de 10 anos (2010-2019) com diagnóstico de HRE. Foram excluídos doentes com história de traumatismo, procedimentos invasivos ou cirurgias nos 14 dias anteriores.RESULTADOS: Foram incluídos 11 doentes; 63,6% eram homens. A idade mediana foi 81 anos. Nove doentes estavam hipocoagulados: 5 com antagonistas da vitamina K, 4 com enoxaparina. O HRE foi o motivo primário de admissão em 45,5% dos casos. Nos restantes, constituiu uma intercorrência de um internamento por outra causa. A apresentaçãoclínica mais comum foi dor abdominal (45,5%), seguida de sintomas de baixo débito (36,4%). Três doentes apresentavam um INR supraterapêutico. Todos os doentes foram tratados de forma conservadora. A mortalidade global aos 30 dias foi 36,4%; a mortalidade intra-hospitalar foi 54,5%. O HRE foi considerado a causa direta da morte em apenas 18,2%. O único fator que se associou a maior mortalidade foi o agravamento da função renal (p=0,029).CONCLUSÃO: O HRE ocorre sobretudo em doentes idosos e hipocoagulados. Associa-se a elevada mortalidade, mas tipicamente não é a causa direta da morte. É difícil identificar fatores preditores de mortalidade, parecendo, contudo, que o agravamento da função renal se associa a maior risco.

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Section: Discussionunclassified

Hematoma Retroperitoneal Espontâneo: A Experiência de um Centro

Beirão

Barreira

Guimarães

2022

Gaz Med

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“…Apixaban is popular direct-acting oral anticoagulant (DOAC) that works by selectively inhibiting both free and prothrombinase complex-associated factor Xa [12]. While apixaban shows lower rates of hemorrhage than warfarin, it still poses a risk to patients with hypertension, congestive heart failure and alcoholism [9,11,13]. We hypothesize that the etiology of ACS in our patient was a soft tissue lower extremity hematoma that expanded secondary to Apixaban use.…”

Section: Introductionmentioning

confidence: 94%

“…Anticoagulants are widely prescribed and used frequently in hospital and outpatient settings to prevent and treat thromboembolism, but double the risk of hemorrhagic complications [11]. Apixaban is popular direct-acting oral anticoagulant (DOAC) that works by selectively inhibiting both free and prothrombinase complex-associated factor Xa [12].…”

Section: Introductionmentioning

confidence: 99%

Acute Lower Extremity Posterior Compartment Syndrome: A Rare Complication of Apixaban Use

Adams¹,

H²,

Shyama³

et al. 2022

Trauma Cases Rev

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Apixaban is an oral anticoagulant that directly inhibits Factor Xa and is indicated for the prophylaxis and treatment of deep venous thrombosis and stroke prevention in nonvalvular atrial fibrillation. Acute lower extremity Posterior Compartment Syndrome is a rare complication of Apixaban use. We present a 78-year-old male with significant medical morbidities taking Apixaban for Atrial Fibrillation presenting with post-traumatic extensive hemorrhagic bullae on the left proximal pretibial region secondary to anticoagulation. We recommend that clinicians develop awareness of the potential for serious bleeding complications of anticoagulants and devise strategies to identify the need for early recognition and prompt management.

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“…In both cases, there was no concomitant use of other antithrombotic or anticoagulant medications. Khan et al, reported a case of spontaneous retroperitoneal hemorrhage in an elderly female taking apixaban for atrial fibrillation, which required admission to the intensive care unit [42]. Table 3 below shows various bleeding complications from DOAC use, as reported in multiple RCTs and observational studies.…”

Section: Epidemiologymentioning

confidence: 99%

“…Bleeding complications from direct oral anticoagulant use[10,20,[22][23][24][25][26][27][30][31][32][33][34][35][37][38][39]42].…”

mentioning

confidence: 99%

A Review of the Incidence Diagnosis and Treatment of Spontaneous Hemorrhage in Patients Treated with Direct Oral Anticoagulants

Gunasekaran

Rajasurya²,

Devasahayam

et al. 2020

JCM

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Anticoagulation carries a tremendous therapeutic advantage in reducing morbidity and mortality with venous thromboembolism and atrial fibrillation. For over six decades, traditional anticoagulants like low molecular weight heparin and vitamin K antagonists like warfarin have been used to achieve therapeutic anticoagulation. In the past decade, multiple new direct oral anticoagulants have emerged and been approved for clinical use. Since their introduction, direct oral anticoagulants have changed the landscape of anticoagulants. With increasing indications and use in various patients, they have become the mainstay of treatment in venous thromboembolic diseases. The safety profile of direct oral anticoagulants is better or at least similar to warfarin, but several recent reports are focusing on spontaneous hemorrhages with direct oral anticoagulants. This narrative review aims to summarize the incidence of spontaneous hemorrhage in patients treated with direct oral anticoagulants and also offers practical management strategies for clinicians when patients receiving direct oral anticoagulants present with bleeding complications.

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Pain in the hip: Spontaneous retroperitoneal hemorrhage in an elderly patient on apixaban

Cited by 10 publications

References 23 publications

Hematoma Retroperitoneal Espontâneo: A Experiência de um Centro

Hematoma Retroperitoneal Espontâneo: A Experiência de um Centro

Acute Lower Extremity Posterior Compartment Syndrome: A Rare Complication of Apixaban Use

A Review of the Incidence Diagnosis and Treatment of Spontaneous Hemorrhage in Patients Treated with Direct Oral Anticoagulants

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