Abstract Apixaban, a direct oral anticoagulant (DOAC), is commonly used for the prevention and treatment of thromboembolic events, with bleeding documented as the most common adverse effect. Spontaneous hemothorax is rare, and bilateral cases are exceedingly rare. We report an 83-year-old man with metastatic hepatocellular carcinoma who developed progressive anemia 10 days after starting apixaban for malignancy-associated cerebrovascular accident. He developed worsening hypoxia and increasing bilateral pleural effusions. Thoracenteses drained 2.3 L of sanguineous fluid from the right and 1.2 L from the left of exudative effusions with hematocrits of 27.9% and 24.4%, respectively, confirming bilateral hemothoraces. Cytology demonstrated malignant cells. Apixaban was discontinued, but pleural effusions reaccumulated, and the patient ultimately succumbed to his malignancy. Although bleeding is a recognized risk of anticoagulation, spontaneous hemothorax, particularly bilateral, is an exceptionally rare manifestation. Prior reports have linked hemothorax to various anticoagulants, but to our knowledge, this is the first reported case of bilateral hemothoraces following apixaban initiation. This case highlights the importance of considering hemothorax as a potential source of unexplained anemia and respiratory decline in anticoagulated patients, especially those with underlying malignancy. Clinicians should maintain a high index of suspicion when evaluating new pleural effusions in patients receiving anticoagulation to ensure timely recognition and management of this potentially life-threatening complication. This abstract is funded by: None
Czelatka et al. (Fri,) studied this question.