Esophageal submucosal hematoma associated with apixaban therapy: a case report

Objective: To describe a rare case of esophageal submucosal hematoma associated with apixaban therapy. Patient and Methods: A 74-year-old female on apixaban for atrial fibrillation presented with retrosternal chest pain and hematemesis. Imaging and endoscopy revealed a large submucosal hematoma in the mid-to-lower esophagus. Conservative treatments including fasting, intravenous fluids, and proton pump inhibitor therapy were initiated, and apixaban treatment was discontinued. Results: Serial endoscopy revealed a progressive resolution of the hematoma, followed by ulcer formation and eventual healing. No arrhythmia recurrence occurred during hospitalization. Anticoagulation was discontinued, and the patient was discharged in good condition. A follow-up endoscopy confirmed complete healing without recurrence. Conclusion: This case highlights the potential risk of esophageal submucosal hematoma in a patient receiving direct oral anticoagulants. Prompt recognition and appropriate conservative management can lead to favorable outcomes. Clinicians should maintain a high index of suspicion of esophageal submucosal hematoma in patients receiving anticoagulation therapy presenting with chest pain and upper gastrointestinal bleeding.