Apixaban nedenli izlenen rektus kılıf hematomu yönetimi ve sonuçları

Öz

Özet Giriş: Apixaban, kanama açısından hem aspirin hem de varfarine kıyasla daha güvenli görünen, nispeten yeni kullanılan bir oral faktör Xa inhibitörüdür. Literatürde apixaban ile ilgili bildirilen çok az yan etki vardır ve bunlardan biri de rektus kılıf hematomudur. Olgu Sunumu: 78 yaşında kadın hasta karın ağrısı, öksürük ve nefes darlığı şikayetlerine ek olarak karın bölgesinde ekimoz ile hastanemiz acil servisine başvurdu. Özgeçmişinde hipertansiyon, astım, koroner arter hastalığı ve nonvalvüler atriyal fibrilasyon olduğu öğrenildi. Hasta nonvalvüler atriyal fibrilasyon nedeniyle 16 aydır apixaban tedavisi görüyordu. Çekilen abdominal ultrasonografi ve bilgisayarlı tomografide yaklaşık 30x40 mm boyutlarında rektus kılıf hematomu saptandı. Hasta konservatif olarak tedavi edildi, ancak solunum yetmezliği nedeniyle exitus gelişti. Sonuç: Klinisyenler karın ağrısı olan hastalarda apixaban kullanan spontan rektus kılıf hematomunun farkında olmalıdır. Apixaban, güvenle kullanılabilen bir ilaç olmasına rağmen spontan kanama gibi komplikasyonlara yol açabilmektedir.

Anahtar Kelimeler

• Rectus abdominis
• hematom
• apixaban

Management and outcomes of spontaneous rectus sheath hematoma with apixaban

Öz

Introduction: Apixaban is a comparatively newly used oral factor Xa inhibitor, which seems to be safer, compared to both aspirin and warfarin in terms of bleeding. There are very few reported apixaban-related side effects in the literature, and one of them is rectus sheath hematoma. Case Report: A 78-year-old female patient was admitted to the emergency service of our hospital with complaints of abdominal pain, cough, and dyspnea, and she also complained of ecchymosis on her abdominal region. Her medical history revealed that she had hypertension, asthma, coronary artery disease, and nonvalvular atrial fibrillation. The patient had been on apixaban for 16 months for nonvalvular atrial fibrillation. Abdominal ultrasonography and computed tomography revealed a rectus sheath hematoma of nearly 30x40 mm in size. The patient managed conservatively, but she died due to respiratory failure. Conclusion: Clinicians should be aware of spontaneous rectus sheath hematoma in apixaban using patients with abdominal pain. Although apixaban is a safe anticoagulant drug, it may cause complications such as spontaneous bleeding.

Anahtar Kelimeler

• Rectus abdominis
• hematoma
• apixaban

Kaynakça

1. 1. Administration DFFadpSSMFaD (2013). [Available from: www.accessdata.fda.gov/scripts/cder/drugsatfda/.
2. 2. Frost CE, Byon W, Song Y, Wang J, Schuster AE, Boyd RA, et al. Effect of ketoconazole and diltiazem on the pharmacokinetics of apixaban, an oral direct factor Xa inhibitor. Br J Clin Pharmacol 2015;79(5):838-46.
3. 3. Administration DFFadpSSMFaD (2018). [Available from: https://www.fda.gov/biologicsbloodvaccines/cellulargenetherapyproducts/approvedproducts/ucm606681.htm.
4. 4. Wong PC, Crain EJ, Xin B, Wexler RR, Lam PY, Pinto DJ, et al. Apixaban, an oral, direct and highly selective factor Xa inhibitor: in vitro, antithrombotic and antihemostatic studies. J Thromb Haemost 2008;6(5):820-9.
5. 5. Hylek EM, Held C, Alexander JH, Lopes RD, De Caterina R, Wojdyla DM, et al. Major bleeding in patients with atrial fibrillation receiving apixaban or warfarin: The ARISTOTLE Trial (Apixaban for Reduction in Stroke and Other Thromboembolic Events in Atrial Fibrillation): Predictors, Characteristics, and Clinical Outcomes. J Am Coll Cardiol 2014;63(20):2141-7.
6. 6. Connolly SJ, Eikelboom J, Joyner C, Diener HC, Hart R, Golitsyn S, et al. Apixaban in patients with atrial fibrillation. N Engl J Med 2011;364(9):806-17.
7. 7. Osinbowale O, Bartholomew JR. Rectus sheath hematoma. Vasc Med 2008;13(4):275-9.
8. 8. Sheth HS, Kumar R, DiNella J, Janov C, Kaldas H, Smith RE. Evaluation of Risk Factors for Rectus Sheath Hematoma. Clin Appl Thromb Hemost 2016;22(3):292-6.

9. 9. Aktas H, Inci S, Dogan P, Izgu I. Spontaneous rectus sheath hematoma in a patient treated with apixaban. Intractable & rare diseases research 2015;5(1):47-9.
10. 10. Gunasekaran K, Winans ARM, Murthi S, Ahmad MR, Kaatz S. Rectus Sheath Hematoma Associated with Apixaban. Clin Pract 2017;7(3):957.
11. 11. Elango K, Murthi S, Devasahayam J, Gunasekaran K. Spontaneous rectus sheath haematoma due to cough on apixaban. BMJ case reports 2018;2018.
12. 12. Theophilus N, Bachuwa G. Rectus sheath haematoma due to drug-drug interaction. BMJ Case Rep 2021;14(5).