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Apixaban-Associated Spontaneous Splenic Rupture-A Case Report
A Abdelhady1, A Ahmed1, Y Mohamed1
1University Hospital Galway, Ireland
Irish Medical Journal
|December 7, 2018
Summary
Direct Oral Anticoagulants (DOACs) can cause spontaneous splenic rupture, even without trauma. This case highlights the importance of considering anticoagulation-related bleeding in patients presenting with abdominal pain and hypotension.
Area of Science:
- Cardiology
- Gastroenterology
- Emergency Medicine
Background:
- A 62-year-old female presented with dizziness, vomiting, and weakness.
- She had recently undergone percutaneous coronary intervention (PCI) and was discharged on Apixaban and Plavix.
- Two days later, she presented with severe hypotension and was diagnosed with splenic hematoma and gastric wall thickening.
Purpose of the Study:
- To report a rare case of spontaneous splenic rupture in a patient on Direct Oral Anticoagulants (DOACs).
- To emphasize the potential for serious gastrointestinal bleeding associated with DOACs, even without a history of trauma.
Main Methods:
- Case report presentation.
- Diagnostic imaging including CT-Abdomen.
- Emergency surgical intervention (laparotomy, splenectomy, partial gastrectomy).
Main Results:
- The patient developed a large splenic hematoma and gastric wall thickening.
- Emergency laparotomy with splenectomy and partial gastrectomy was performed.
- Post-operative sepsis was treated successfully with antibiotics.
Conclusions:
- Spontaneous splenic rupture is a rare but serious complication that can occur in patients on DOACs.
- Abdominal pain and hemodynamic instability in patients on anticoagulation warrant prompt investigation for intra-abdominal bleeding.
- Lifelong prophylactic antibiotics were initiated post-discharge.
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