Spontaneous splenic rupture associated with apixaban: a case report

Area of Science:

• Internal Medicine
• Cardiology
• Hematology

Background:

• Spontaneous splenic rupture is a rare but critical condition, particularly in patients using anticoagulants.
• The increasing use of novel oral anticoagulants necessitates heightened clinical awareness for this potential complication.
• Prompt diagnosis and management are crucial for improving patient outcomes in cases of splenic rupture.

Observation:

• A case report of an 83-year-old male patient presenting with sudden severe abdominal pain.
• The patient had a history of chronic atrial fibrillation treated with apixaban (2.5 mg twice daily).
• Abdominal CT revealed a large splenic hematoma and intraperitoneal bleeding, leading to hypovolemic shock.

Findings:

• The patient experienced rapid clinical decline with signs of hypovolemic shock and anemia.
• Splenic arteriography identified active bleeding, which was initially managed with embolization.
• Recurrent bleeding necessitated a subsequent exploratory laparotomy and splenectomy.

Implications:

• Spontaneous splenic rupture should be considered in patients on apixaban who present with abdominal pain, hypotension, and anemia.
• For hemodynamically unstable patients, emergent splenic artery embolization or splenectomy is critical.
• This case underscores the importance of recognizing apixaban-associated splenic rupture for timely and potentially life-saving interventions.