A Probable Life-Saving Switch from Apixaban to Phenprocoumon

Authors

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

DOI:

https://doi.org/10.1532/hsf.1268

Abstract

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.

References

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Published

2015-10-28

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

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