Bleeding Complications Following Paracentesis in Patients Taking Apixaban

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.