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Apixaban-induced liver injury.
Sherri-Anne Clarke1, Ali A Alsaad2, Anwar Mack2
1Medical University of the Americas, Charlestown, Saint Kitts and Nevis.
BMJ Case Reports
|September 22, 2016
Summary
This case report highlights a rare instance of liver injury caused by apixaban, a common anticoagulant. Discontinuation of apixaban led to symptom resolution, emphasizing the need for physician awareness of this adverse effect.
Area of Science:
- Pharmacology
- Hepatology
- Internal Medicine
Background:
- Atrial fibrillation necessitates anticoagulation for stroke prevention.
- Novel oral anticoagulants like apixaban are widely prescribed.
- Drug-induced liver injury (DILI) is a significant concern in pharmacotherapy.
Observation:
- An 81-year-old woman developed acute liver injury with elevated liver enzymes three days after starting apixaban for atrial fibrillation.
- Symptoms included abdominal pain, shortness of breath, and weakness.
- Infectious and autoimmune causes for the elevated transaminases were ruled out.
Findings:
- Apixaban was identified as the probable cause of hepatocellular injury.
- Discontinuation of apixaban resulted in the resolution of the patient's symptoms and normalization of liver enzymes.
- Hepatotoxicity secondary to apixaban is a rare but important adverse effect.
Implications:
- Physicians should consider apixaban-induced hepatotoxicity in patients presenting with unexplained liver enzyme elevation.
- Awareness of this rare adverse effect is crucial for safe prescribing of novel oral anticoagulants.
- Prompt recognition and management, including drug discontinuation, can lead to favorable patient outcomes.
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