Apixaban-Associated Diffuse Alveolar Hemorrhage in an Elderly Man with Multiple Complications.
Takuya OzawaHideki TeraiAkiyoshi KajinoShiro OtakeAyaka SaitoMiyuki NishieYoshikazu KishinoHirofumi KamataKentaro HayashidaMakoto IshiiKoichi FukunagaPublished in: The American journal of case reports (2022)
BACKGROUND Diffuse alveolar hemorrhage (DAH) caused by direct oral anticoagulants (DOACs) has increased in recent years with the increase in prescriptions of DOACs. Generally, DOACs are considered to have a lower bleeding risk than the traditional anticoagulant, warfarin. However, major bleeding, including DAH, due to DOACs can be seen in clinical practice, and there are few reports to elucidate when DOAC-associated alveolar hemorrhage occurs and whether DOAC-induced DAH has a trigger. CASE REPORT An 80-year-old man diagnosed and treated for atrial fibrillation with apixaban 2.5 mg twice daily for 1 year before admission, underwent 2 invasive medical procedures over a short period of time. Hemoptysis began after the procedures. He experienced shortness of breath and rapidly progressive hypoxic respiratory failure. His postsurgical oxygen saturation level dropped rapidly. Chest radiography and computed tomography images showed pulmonary infiltration and ground-glass opacity in both lungs. Apixaban treatment was discontinued, and mechanical ventilation was initiated. Bronchoalveolar lavage cytology revealed hemosiderin-laden macrophages. A diagnosis of diffuse alveolar hemorrhage (DAH) was made. In previous reports about DAH caused by DOACs, most patients had bleeding triggers; drug interactions in patients taking DOACs are one of such triggers. Although DOACs are relatively safe for elderly patients, DAH can occur in patients receiving either early-stage or long-term treatment. CONCLUSIONS The onset of DOAC-associated DAH is not limited to the early stages of medication initiation. Various triggers can induce DAH in patients receiving DOACs.
Keyphrases
- direct oral anticoagulants
- atrial fibrillation
- venous thromboembolism
- oral anticoagulants
- left atrial
- catheter ablation
- mechanical ventilation
- left atrial appendage
- end stage renal disease
- computed tomography
- early stage
- respiratory failure
- heart failure
- newly diagnosed
- ejection fraction
- case report
- percutaneous coronary intervention
- chronic kidney disease
- clinical practice
- emergency department
- multiple sclerosis
- magnetic resonance imaging
- acute respiratory distress syndrome
- extracorporeal membrane oxygenation
- risk factors
- prognostic factors
- peritoneal dialysis
- deep learning
- machine learning
- squamous cell carcinoma
- high grade
- patient reported outcomes
- mitral valve
- high glucose
- contrast enhanced
- endothelial cells