Acute gastrointestinal hemorrhage due to apatinib

Abstract

A 29-year-old man with malignant pheochromocytoma was treated with oral apatinib 500 mg once daily. One week later, the apatinib was decreased 375 mg once daily due to increased blood pressure. Thirty-seven days after drug administration, he developed bloody stool 50 ml and apatinib was withdrawn. Four days later, the original dosage of apatinib was given because of disease progression. On day 9, he developed bloody stool 600 ml. On day 10, he developed bloody stool 2 300 ml and vomited coffee-ground-like gastric content about 1 000 ml. He received an IV pumping of octreotide acetate, IV infusions of hydroxyethyl starch 40 sodium chloride, carbazochrome sodium sulfonate, etamsylate and aminomethylbenzoic acid. Laboratory tests revealed the following levels: RBC 1.2×1012/L, Hb 37 g/L, thrombin time 17 s, prothrombin time 22 s, D-dimer 3.3 mg/L, calcium 1.22 mmol/L, potassium 2.5 mmol/L, total protein 26 g/L, albumin 15 g/L, creatinine 12 μmol/L, uric acid 29 μmol/L. Apatinib induced acute gastrointestinal hemorrhage was considered. Apatinib was withdrawn. He was given pressurized by intravenous infusion of suspended red blood cells, IV infusions of carbazochrome sodium sulfonate and glucose gluconate. The next morning, he experienced bloody stool 2 500 ml and vomited coffee-ground-like gastric content about 500 ml. He received oral lyophilized thrombin powder, pressurized by intravenous infusion of suspended red blood cells, IV infusions of dopamine hydrochloride and human albumin, intramuscular injection of vitamin K1, IV infusion of lansoprazole, etamsylate, aminome-thylbenzoic acid, pantoprazole sodium and fat emulsion amino acids (17) and glucose (11%). At the noon of the same day, he experienced melena about 80 g. He was given oral lyophilized thrombin powder. On day 2 after apatinib withdrawal, he experienced melena 30 g. On day 4, laboratory tests revealed the following levels again: RBC 2.6×1012/L, Hb 95 g/L, thrombin time 14 s, prothrombin time 16 s, D-dimer 1.9 mg/L, calcium 2.35 mmol/L, potassium 4.0 mmol/L, total protein 52 g/L, albumin 32 g/L, creatinine 28 μmol/L, uric acid 191 μmol/L. Nutrition supportive, liver and stomach protecting treatments continued, gastrointestinal hemorrhage did not recur. Key words: Gastrointestinal hemorrhage; Apatinib