Unmasking the Hidden Risk: Urticaria and Angioedema with Direct Oral Anticoagulants

Direct oral anticoagulants (DOACs), such as rivaroxaban and dabigatran, are widely used for thromboembolic conditions. While bleeding is the most well-recognized adverse effect, rare cutaneous hypersensitivity reactions, such as urticaria and angioedema, are increasingly reported. We describe a case series of nine patients who developed cutaneous hypersensitivity reactions to DOACs. All patients developed symptoms within 1-10 days of DOAC initiation. Rivaroxaban was associated with angioedema and urticaria, whereas dabigatran was limited to urticaria. All reactions resolved after drug discontinuation and symptomatic treatment. Dermatologic adverse effects of DOACs, although uncommon, warrant heightened clinical suspicion. A limitation of this study is the small sample size and absence of rechallenge confirmation of hypersensitivity. Management should be individualized. Increased awareness among dermatologists and physicians is crucial for timely management and pharmacovigilance.