title: Fatal consequences of climbing a ladder under apixaban and drunken.
abstract: BACKGROUND
  Apixaban, a factor-Xa-inhibitor, is one of the non-vitamin-K-antagonist oral anticoagulants (NOACs) which are increasingly used in atrial fibrillation (AF). In real life even patients with contraindications to vitamin K antagonists (VKAs) receive NOAC because NOAC are considered as "safer" than VKAs.
  
  
  METHODS
  In a 61-years-old man with hypertension, heart failure and paroxysmal AF apixaban was started. Despite advices from his physicians, he continued alcohol abuse and suffered from recurrent falls. After 9 months he fell from a ladder and suffered from extensive subarachnoidal and intraparenchymal hemorrhages, subdural hematoma, brain edema with midline shift and a left-sided skull fracture. Because of the inability to reverse the anticoagulant therapy, no neurosurgical intervention was carried out and the patient died without regaining consciousness.
  
  
  CONCLUSIONS
  Patients with recurrent falls or chronic alcohol abuse should not be considered as candidates for NOACs. If anticoagulation is deemed necessary, VKA with its potential for prompt reversibility should be favored.
authors.affiliation: Krankenanstalt Rudolfstiftung, Wien, Austria. Electronic address: claudia.stoellberger@chello.at.
authors.forename: Claudia
authors.initials: C
authors.lastname: Stöllberger
authors.affiliation: Krankenanstalt Rudolfstiftung, Wien, Austria. Electronic address: fifigs1@yahoo.de.
authors.forename: Josef
authors.initials: J
authors.lastname: Finsterer
mesh_terms: D000058:Accidental Falls; D000435:Alcoholic Intoxication / Q000150:complications*; D001281:Atrial Fibrillation / Q000188:drug therapy*; D006259:Craniocerebral Trauma / Q000209:etiology*; D065427:Factor Xa Inhibitors / Q000627:therapeutic use*; D017809:Fatal Outcome; D006801:Humans; D008297:Male; D008875:Middle Aged; D011720:Pyrazoles / Q000627:therapeutic use*; D011728:Pyridones / Q000627:therapeutic use*
chemical_list: D065427:Factor Xa Inhibitors; D011720:Pyrazoles; D011728:Pyridones; C522181:apixaban
keywords: Anticoagulation; Apixaban; Atrial fibrillation; Cerebral hemorrhage