Key result
Co-administration of apixaban and the strong CYP3A4 inhibitor cobicistat resulted in a large retroperitoneal hemorrhage in a patient who recently underwent a femoral artery stent procedure.
Why the study?
Direct oral anticoagulant drug-to-drug interactions are underrecognized by clinicians, and strong CYP3A4 inhibitors may alter apixaban blood levels.
Case Report (n=1)
Co-administration of apixaban with strong CYP3A4 and P-gp inhibitors like cobicistat can lead to severe bleeding complications, particularly following vascular procedures.
Clinicians should screen for CYP3A4 interactions with apixaban in HIV patients; this single case leaves open the interaction's true bleeding risk.
Direct oral anticoagulants (DOACs) drug-to-drug interactions are underrecognized by clinicians. Apixaban has cytochrome 450 (CYP) mediated metabolism (primarily by CYP3A4). Strong inducers and inhibitors of this enzyme may cause variations in the blood level of apixaban. This report presents a patient who received a femoral artery stent and developed a large retroperitoneal hemorrhage after she was prescribed apixaban in addition to her antiretroviral therapy (AVT) regimen that included cobicistat, a strong CYP3A4 inhibitor. The patient was managed conservatively, and a repeat computed tomography scan in a subsequent admission revealed near resolution of the hematoma. The treating physicians realized that apixaban should not be prescribed with a potent CYP3A4 inhibitor like cobicistat and discontinued it.
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Ammar et al. (2021) conducted a case report in Retroperitoneal hemorrhage due to drug interaction (n=1). Apixaban and Cobicistat co-administration was evaluated on Retroperitoneal hemorrhage. Co-administration of apixaban and the strong CYP3A4 inhibitor cobicistat resulted in a large retroperitoneal hemorrhage in a patient who recently underwent a femoral artery stent procedure.
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