Key result
Apixaban after upper GI cancer resection linked to unexpected plasma overexposure, stroke, and bleeding.
Why the study?
Altered direct oral anticoagulant plasma levels can cause spontaneous hemorrhagic or thrombotic complications, but DOAC exposure in special populations like major gastrointestinal surgery requires further description.
Does major gastrointestinal tract surgery alter apixaban plasma levels and affect clinical outcomes in patients with non-valvular atrial fibrillation?
Case Report (n=1)
Does major gastrointestinal tract surgery alter apixaban plasma levels and affect clinical outcomes in patients with non-valvular atrial fibrillation?
Answers are grounded in this paper and cite their sources.
Major gastrointestinal surgery may unpredictably alter DOAC plasma exposure, suggesting that periodic drug monitoring could help optimize therapy and reduce adverse events in special patient populations.
Altered direct oral anticoagulant (DOAC) plasma levels can lead either to spontaneous hemorrhagic or thrombotic complications. We describe a case of suspected altered apixaban disposition in a patient with an upper gastrointestinal cancer resection treated with apixaban for non-valvular atrial fibrillation. Diagnosis of ischemic stroke for left hemiparesis was confirmed due to recent emergence of a hypodense area in the posterior capsular nucleus of ischemic reference in a context of binuclear capsular lacunar lesions. Thus, apixaban underexposure was suspected from anamnestic data and oral anticoagulation was switched to parenteral at the next scheduled dose for stroke recurrence. Before switching apixaban pharmacokinetic analysis was performed and unexpectedly showed apixaban plasma overexposure. After 3 days from the switch, the patient experienced spontaneous bleeding complications, for which the risk-benefit profile of continuing anticoagulant treatment for stroke recurrences warranted treatment discontinuation. Unexpected DOAC plasma exposure may present in special patient populations with thrombotic and bleeding complications. Though universally recognized therapeutic ranges have yet to be established for DOACs, periodic drug monitoring may aid in guiding optimization of DOAC therapy and reduce the risk of adverse events in special patient populations.
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Baiardi et al. (2023) conducted a case report in Non-valvular atrial fibrillation and upper gastrointestinal cancer resection (n=1). Apixaban was evaluated on Apixaban plasma exposure and clinical complications. Apixaban treatment in a patient with upper gastrointestinal cancer resection resulted in unexpected plasma overexposure, ischemic stroke, and subsequent spontaneous bleeding complications.
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