Apixaban-induced liver injury.
Apixaban-induced liver injury.
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DOI：
10.1136/bcr-2016-216744
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发表时间：
2016-09-20
期刊：
影响因子：
0.9
通讯作者：
Phillips, Michael B
中科院分区：
文献类型：
--
作者：
Clarke, Sherri-Anne;Alsaad, Ali A;Phillips, Michael B
一名81岁的高血压控制良好的女性，因新发房颤伴快速心室反应到急诊科就诊。开始房颤治疗，包括心率控制和抗凝治疗，阿哌沙班5 mg，每日两次，用于一级卒中预防。 开始阿哌沙班治疗后3天，患者出现新发腹痛、呼吸短促和虚弱加重。化验结果显示肝酶升高。转氨酶升高的检查未发现任何潜在的感染或自身免疫过程。阿哌沙班（肝细胞损伤的可能原因）停药，并更换为静脉注射普通肝素，以桥接华法林抗凝。由于阿哌沙班停药后转氨酶改善，患者症状消退。我们说明了这种情况下，药物诱导的肝毒性继发于阿哌沙班治疗。重要的是，医生要意识到这种罕见的不良反应引起的广泛使用的新型口服抗凝剂。
An 81-year-old woman with well-controlled hypertension presented to the emergency department with new-onset atrial fibrillation with rapid ventricular response. Treatment for atrial fibrillation was initiated, including rate control and anticoagulation with 5 mg of apixaban two times per day for primary stroke prophylaxis. Three days after initiation of apixaban, the patient noted new-onset abdominal pain, worsening shortness of breath and weakness. Laboratory results showed elevated liver enzymes. Workup for elevated transaminase did not reveal any underlying infectious or autoimmune process. Apixaban, a probable cause for the hepatocellular injury, was discontinued and replaced with intravenous unfractionated heparin to bridge anticoagulation with warfarin. The patient's symptoms resolved as her transaminases improved by discontinuation of apixaban. We illustrate this case of drug-induced hepatotoxicity secondary to treatment with apixaban. It is important for physicians to be aware of this rare adverse effect caused by a widely used novel oral anticoagulant.