A Probable Life-Saving Switch from Apixaban to Phenprocoumon


  • Claudia Stöllberger Krankenanstalt Rudolfstiftung, Wien,
  • Josef Finsterer Krankenanstalt Rudolfstiftung, Wien,




The direct oral anticoagulants (DOAC) dabigatran, rivaroxaban, and apixaban are increasingly prescribed in atrial fibrillation (AF) patients, although dosage in elderly patients, safety in chronic kidney disease, food- and drug-interactions, laboratory tests for monitoring, and antidote are not clarified. In a 78-year-old man with an acute stroke, paroxysmal AF and sick-sinus-syndrome were detected as he received a DDD-pacemaker and 5 mg apixaban/bid. He had a history of hypertension, hypothyroidism, diabetes mellitus, hyperlipidemia, sleep apnea, lumbar discopathy, and nephropathy. Renal function deteriorated after 2 months, and apixaban was changed to phenprocoumon. Three months later, he suffered from abdominal pain and hemorrhagic shock due to rupture of an infrarenal aortic aneurysm. After reversal of the anticoagulation with prothrombin-complex concentrate, a stent-graft with exclusion of the aneurysm was implanted. Switching from apixaban to phenprocoumon was probably life-saving. Vitamin-K-antagonists should be preferred to DOAC in patients with AF and vascular disease.


Aubert J, Delalande JP, Skowronski P. 2013. Aneurysm of abdominal aorta rupture in a patient on dabigatran treatment. Ann Fr Anesth Reanim 32:271-2.

Harel Z, Sood MM, Perl J. 2015. Comparison of novel oral anticoagulants versus vitamin K antagonists in patients with chronic kidney disease. Curr Opin Nephrol Hypertens 24:183-92.

Jones WS, Hellkamp AS, Halperin J, et al. 2014. Efficacy and safety of rivaroxaban compared with warfarin in patients with peripheral artery disease and non-valvular atrial fibrillation: insights from ROCKET AF. Eur Heart J 35:242-9.

Kent KC, Zwolak RM, Egorova NN, et al. 2010. Analysis of risk factors for abdominal aortic aneurysm in a cohort of more than 3 million individuals. J Vasc Surg 52:539-48.

Lip GY, Nieuwlaat R, Pisters R, Lane DA, Crijns HJ. 2010. Refining clinical risk stratification for predicting stroke and thromboembolism in atrial fibrillation using a novel risk factor-based approach: the euro heart survey on atrial fibrillation. Chest 137:263-72.



How to Cite

Stöllberger, C., & Finsterer, J. (2015). A Probable Life-Saving Switch from Apixaban to Phenprocoumon. The Heart Surgery Forum, 18(5), E186-E187. https://doi.org/10.1532/hsf.1268




Most read articles by the same author(s)