Apixaban-induced subdural bleeding: case presentation and literature review

Area of Science:

• Pharmacology
• Neurology
• Hematology

Background:

• Apixaban is a direct factor Xa inhibitor and a non-vitamin K dependent oral anticoagulant.
• It is known for having the lowest rate of intracranial bleeding among similar anticoagulants.
• This case involves a 60-year-old male with hypertension and oligodendroglioma on apixaban for deep venous thrombosis.

Observation:

• The patient presented with decreased level of consciousness and slurred speech.
• Rapid neurological deterioration was observed.
• The patient was on apixaban for deep venous thrombosis.

Findings:

• A rare case of subdural bleeding associated with apixaban use is reported.
• The bleeding event led to significant neurological decline.
• Neurosurgical intervention was required.

Implications:

• This case underscores the potential risk of subdural bleeding with apixaban, despite its favorable safety profile.
• Prompt recognition and neurosurgical intervention are crucial for managing such rare complications.
• Further research may be needed to fully understand the risk factors and management strategies for apixaban-associated intracranial hemorrhages.