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Area of Science:

  • Pharmacology
  • Pulmonology
  • Hematology

Background:

  • Anticoagulant therapy, particularly with direct oral anticoagulants (DOACs) like edoxaban, carries a risk of bleeding.
  • Major bleeding events (intracranial, gastrointestinal, retroperitoneal) are known adverse effects of edoxaban.
  • The absence of a readily available reversal agent for DOACs complicates the management of severe bleeding complications.

Purpose of the Study:

  • To report a case of diffuse alveolar hemorrhage (DAH) potentially associated with edoxaban therapy.
  • To highlight the risks of DOACs in critically ill patients.
  • To emphasize the need for caution when prescribing edoxaban.

Main Methods:

  • A case report detailing a 51-year-old female patient with multiple traumatic injuries.
  • Administration of edoxaban for deep venous thrombosis.
  • Clinical presentation of dyspnea, diagnostic imaging (chest CT), and laboratory workup for pulmonary hemorrhage.

Main Results:

  • The patient developed dyspnea and bilateral diffuse ground-glass opacities on chest CT, leading to a diagnosis of DAH.
  • Extensive workup for autoimmune and infectious causes of DAH was negative.
  • Pulmonary opacities resolved spontaneously after discontinuation of edoxaban therapy.

Conclusions:

  • Diffuse alveolar hemorrhage (DAH) is a potentially life-threatening complication associated with edoxaban.
  • DOACs, including edoxaban, require careful consideration and monitoring, especially in patients with critical conditions.
  • Physicians should exercise caution when prescribing edoxaban due to the risk of severe, unreversed bleeding events.