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Hemostasis is a crucial process that prevents excessive blood loss from damaged blood vessels. It involves various mechanisms such as vasoconstriction, platelet adhesion and activation, and fibrin formation. The importance of each mechanism depends on the type of vessel injury. In contrast, thrombosis is the abnormal formation of a blood clot within the blood vessels, leading to potential complications if the clot obstructs blood flow. Thrombosis can be caused by increased coagulability of the...
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Hemostasis, the process that stops bleeding after a blood vessel injury, is crucial for maintaining the integrity of the circulatory system. However, disorders of hemostasis can disrupt this delicate balance, leading to either excessive clotting or bleeding. These disorders can be broadly classified into thromboembolic disorders and bleeding disorders.
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Esophageal varices often manifest as gastrointestinal bleeding episodes, presenting symptoms like hematemesis (vomiting of blood), hematochezia (passing fresh blood via the rectum), and melena (black, tarry stools). Other signs can include weight loss, anorexia, abdominal discomfort, jaundice, pruritus, altered mental status, and muscle cramps.
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Intravenous regional anesthesia or the Bier block technique is used to anesthetize a specific limb or extremity. It uses exsanguinated or blood-drained vessels to transport local anesthetics or LAs to the peripheral nerve trunks. Lidocaine without vasoconstrictors like epinephrine is most commonly used for this technique. Other drugs used are prilocaine, ropivacaine, and chloroprocaine. Bupivacaine is not recommended for this technique due to its high cardiac toxicity.
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Bleeding Complications Following Paracentesis in Patients Taking Apixaban.

Sarah Van Dorin1, Andrei Schwartz1, Rosarie Tudas2

  • 1Internal Medicine, University of Iowa Hospitals and Clinics, Iowa City, USA.

Cureus
|April 9, 2025
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Summary
This summary is machine-generated.

Direct oral anticoagulants like apixaban increase bleeding risk during paracentesis. High doses, recent administration, or concurrent anticoagulants significantly raise hemorrhagic complication rates.

Keywords:
abdominal paracentesisapixabancirrhosisperioperative medication managementperiprocedural bleedingtherapeutic anticoagulation

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Area of Science:

  • Hepatology
  • Cardiology
  • Pharmacology

Background:

  • Ascites and thrombosis are common in liver disease.
  • Abdominal paracentesis is a procedure to drain ascites.
  • The risk of bleeding from paracentesis in patients on direct oral anticoagulants (DOACs) like apixaban is not well understood.

Purpose of the Study:

  • To quantify the rate of major bleeding in patients undergoing paracentesis while on apixaban.
  • To identify risk factors associated with bleeding complications.

Main Methods:

  • Retrospective cohort study of patients exposed to apixaban within seven days of paracentesis.
  • Data collected included bleeding complications, apixaban dosing and timing, and patient comorbidities.
  • Study conducted at a single US academic hospital from January 2016 to April 2022.

Main Results:

  • 365 paracenteses in 91 patients were analyzed.
  • 20 hemorrhages (5.5%) occurred, with 9 (2.5%) plausibly procedure-related.
  • Fatal hemorrhage occurred in 4 patients (1.1%).
  • Increased bleeding risk was associated with apixaban 10 mg twice daily, concurrent anticoagulants, apixaban within 6 hours of procedure, and inpatient status.

Conclusions:

  • The bleeding rate after paracentesis in patients on apixaban is higher than historical estimates.
  • Apixaban exposure, particularly high doses, recent administration, or combined with other anticoagulants, significantly elevates hemorrhagic risks.