title: Apixaban-induced liver injury.
abstract: An 81-year-old woman with well-controlled hypertension presented to the emergency department with new-onset atrial fibrillation with rapid ventricular response. Treatment for atrial fibrillation was initiated, including rate control and anticoagulation with 5 mg of apixaban two times per day for primary stroke prophylaxis. Three days after initiation of apixaban, the patient noted new-onset abdominal pain, worsening shortness of breath and weakness. Laboratory results showed elevated liver enzymes. Workup for elevated transaminase did not reveal any underlying infectious or autoimmune process. Apixaban, a probable cause for the hepatocellular injury, was discontinued and replaced with intravenous unfractionated heparin to bridge anticoagulation with warfarin. The patient's symptoms resolved as her transaminases improved by discontinuation of apixaban. We illustrate this case of drug-induced hepatotoxicity secondary to treatment with apixaban. It is important for physicians to be aware of this rare adverse effect caused by a widely used novel oral anticoagulant.
authors.affiliation: Medical University of the Americas, Charlestown, Saint Kitts and Nevis.
authors.forename: Sherri-Anne
authors.initials: SA
authors.lastname: Clarke
authors.affiliation: Department of Internal Medicine, Mayo Clinic, Jacksonville, Florida, USA.
authors.forename: Ali A
authors.initials: AA
authors.lastname: Alsaad
authors.affiliation: Department of Internal Medicine, Mayo Clinic, Jacksonville, Florida, USA.
authors.forename: Anwar
authors.initials: A
authors.lastname: Mack
authors.affiliation: Department of Internal Medicine, Mayo Clinic, Jacksonville, Florida, USA.
authors.forename: Michael B
authors.initials: MB
authors.lastname: Phillips
mesh_terms: D015746:Abdominal Pain / Q000139:chemically induced*; D000284:Administration, Oral; D000369:Aged, 80 and over; D000925:Anticoagulants / Q000008:administration & dosage / Q000009:adverse effects*; D001281:Atrial Fibrillation / Q000188:drug therapy* / Q000503:physiopathology; D056486:Chemical and Drug Induced Liver Injury / Q000175:diagnosis*; D005260:Female; D006493:Heparin / Q000627:therapeutic use*; D006801:Humans; D017410:Practice Guidelines as Topic; D011720:Pyrazoles / Q000008:administration & dosage / Q000009:adverse effects*; D011728:Pyridones / Q000008:administration & dosage / Q000009:adverse effects*; D016896:Treatment Outcome
chemical_list: D000925:Anticoagulants; D011720:Pyrazoles; D011728:Pyridones; C522181:apixaban; D006493:Heparin