Apixaban (Eliquis)-Induced Rash: A Case Report

Area of Science:

• Pharmacology
• Dermatology
• Cardiology

Background:

• Anticoagulants like apixaban are widely used for thromboembolism prophylaxis and treatment.
• Apixaban is a direct oral anticoagulant that inhibits factor Xa.
• Hypersensitivity reactions are a known, albeit less common, side effect of apixaban.

Observation:

• A 74-year-old female with a history of pemphigus vulgaris was treated with apixaban for pulmonary embolism and deep vein thrombosis.
• Three days after initiating apixaban, the patient developed pruritic, erythematous dermatitis on her torso, back, and lower extremities.
• The patient's symptoms were consistent with a hypersensitivity reaction to apixaban.

Findings:

• The patient's apixaban treatment was discontinued due to the suspected hypersensitivity reaction.
• Dabigatran, a direct thrombin inhibitor, was initiated as an alternative anticoagulant.
• Clinical improvement in dermatitis was observed five days after switching anticoagulants.

Implications:

• This case underscores the importance of considering hypersensitivity reactions, particularly dermatitis, in patients initiating apixaban.
• Patients with pre-existing dermatological conditions may warrant closer monitoring for adverse skin reactions.
• Alternative anticoagulants should be considered in cases of suspected apixaban-induced hypersensitivity.