[Repeated Cerebellar Hemorrhage Related to Rivaroxaban and Apixaban: A Case Report]

We report a case of repeated cerebral hemorrhage associated with administration of rivaroxaban and apixaban. A 74-year-old man had undergone catheter ablation for non-valvular paroxysmal atrial fibrillation in 2 years prior. Warfarin treatment was continued after successful catheter ablation, and was then changed to rivaroxaban in 1 year prior. Three months later, he developed subcortical cerebral hemorrhage in the right occipital lobe and pharmacotherapy was changed to apixaban. At the current presentation, he complained of headache and left visual field defect, and was admitted to our hospital. Computed tomography of the head revealed recurrent hematoma at the same site as the previous hemorrhagic lesion. Administration of apixaban was subsequently stopped. Magnetic resonance imaging of the head revealed no vascular anomalies around the hemorrhagic lesion, except for two microbleeds in the left cerebral cortex, suggesting amyloid angiopathy. We report the current case from the perspective of whether anticoagulation should be continued after successful catheter ablation, and whether anticoagulation is appropriate in patients with microbleed signals in the cerebral cortex.