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Apixaban-induced liver injury.

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New oral anticoagulants like apixaban can cause drug-induced liver injury. This case study highlights a probable link between apixaban and toxic hepatitis, emphasizing the need for vigilance.

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Area of Science:

  • Hepatology
  • Pharmacovigilance
  • Internal Medicine

Background:

  • New oral anticoagulants (NOACs), including apixaban, are increasingly prescribed for anticoagulation.
  • While generally considered safe, potential adverse drug reactions require ongoing monitoring.
  • Drug-induced liver injury (DILI) is a significant concern with various medications.

Observation:

  • An 85-year-old patient developed mixed-profile toxic hepatitis.
  • Apixaban was identified as the likely causative agent based on clinical presentation and causality assessment (CIOMS/RUCAM score of 7).
  • Liver biopsy excluded autoimmune hepatitis, and other etiological factors were ruled out.

Findings:

  • The patient's liver injury significantly improved after discontinuing apixaban.
  • Despite a previous meta-analysis suggesting no increased risk of hepatotoxicity with apixaban, over 120 potential cases are reported in EudraVigilance.
  • This case suggests a probable causal relationship between apixaban and liver injury.

Implications:

  • Apixaban should be considered a potential cause of drug-induced liver injury.
  • Clinicians should maintain a high index of suspicion for hepatotoxicity in patients taking apixaban.
  • Further pharmacovigilance studies are warranted to fully elucidate the risk of apixaban-associated liver injury.