Reactions 1871, p71 - 4 Sep 2021
Apixaban S
Haematochezia: case report
A 67-year-old man developed haematochezia during treatment with apixaban for deep vein thrombosis (DVT).
The man, who had various comorbidities, was admitted to the emergency department with fever, chills, cough and shortness of breath. He was eventually diagnosed with Coronavirus disease 2019 (COVID-19) pneumonia, which was complicated by acute hypoxic respiratory failure. He received off-label treatment with oral azithromycin 500mg daily (5 doses), oral hydroxychloroquine 400mg 2 times daily (2 doses) followed by 200mg 2 times daily (8 doses), ceftriaxone, vancomycin, piperacillin/tazobactam and cefazolin for the COVID-19 pneumonia. During the hospital stay, he developed an acute occlusive DVT of his right peroneal vein, for which he started receiving apixaban [dosage and route not stated]. Additionally, he also developed multiple complications. On day 33 of hospitalisation, he had several episodes of frank red blood with clots per rectum consistent with haematochezia. After the bleeding episode, his BP dropped, indicating haemodynamic instability. At the time of GI bleeding, he had also been receiving off- label treatment with salbutamol [albuterol], furosemide, oxycodone and piperacillin/tazobactam for the COVID-19 pneumonia.
Additionally, he had been receiving pantoprazole, aspirin and fluconazole concomitantly.
The man’s treatment with apixaban was therefore discontinued temporarily in the setting of active bleeding. Colonoscopy findings were consistent with ischaemic ulcerative colitis. Based on these findings, clinical presentation and after excluding other aetiologies, it was concluded that the haematochezia might have caused due to the ischaemic ulcerative colitis and treatment with apixaban might also have contributed in the development of haematochezia [duration of treatment to reaction onset not stated]. On day 34, GI bleeding resolved spontaneously.
The man’s treatment with apixaban was restarted then, without further complications. His condition improved clinically, and the COVID-19 test revealed negative results on days 40 and 42. On day 49, he was discharged home with rehabilitation and continues to be followed up as an outpatient.
Cho M, et al. Clinical and Intestinal Histopathological Findings in SARS-CoV-2/COVID-19 Patients with Hematochezia. Case Reports in Gastroenterology 15: 408-417, No.
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