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Microsurgical Venous Pouch Arterial-Bifurcation Aneurysms in the Rabbit Model: Technical Aspects

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Major Bleeding After Paracentesis Associated With Apixaban Use: Two Case Reports.

Ethan Kuperman¹, Ryan A Hobbs²

¹The University of Iowa Roy J and Lucille A Carver College of Medicine, Iowa City, IA, USA.

Hospital Pharmacy

|January 16, 2023

Summary

Patients with cirrhosis on apixaban may face high bleeding risk during paracentesis. This procedure may require careful consideration and further research in this patient group.

Keywords:

adverse drug reactions anticoagulants gastrointestinal disorders medication safety

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Area of Science:

Hepatology
Nephrology
Pharmacology

Background:

Paracentesis is generally considered safe without anticoagulation interruption.
Cirrhosis and renal impairment can alter drug pharmacokinetics.
Apixaban is a common anticoagulant used in various clinical settings.

Observation:

Two patients with compensated cirrhosis and moderate renal impairment experienced severe bleeding after paracentesis.
Both patients were concurrently receiving therapeutic doses of apixaban.

Findings:

Concurrent apixaban therapy in patients with cirrhosis and renal impairment may increase bleeding risk during paracentesis.
Elevated apixaban concentrations in this population could contribute to unexpected bleeding complications.

Implications:

Paracentesis in cirrhotic patients on apixaban may warrant closer monitoring or procedural modification.
Further research is needed to establish the safety profile of apixaban in Child-Pugh B cirrhosis patients undergoing invasive procedures.
Clinical guidelines may need updating regarding anticoagulation management during paracentesis in high-risk patient groups.