Abstract
Atraumatic adrenal hemorrhage is a rare injury, often due to the disruption of normal hemostasis secondary to sepsis, autoimmune disease, or chronic anticoagulation. We present a case of recurrent adrenal hemorrhage in a patient with antiphospholipid syndrome previously maintained on warfarin for deep vein thrombosis and pulmonary embolism prophylaxis who worsened shortly after transition to apixaban therapy. Initial left-sided adrenal hemorrhage occurred four weeks after beginning apixaban, followed by the development of retinal hemorrhage and later right-sided adrenal hemorrhage. This is, to date, the first reported case of adrenal hemorrhage in a patient receiving chronic anticoagulation with apixaban.
Highlights
Adrenal hemorrhage presents a diverse yet potentially life-threatening family of injuries of variable etiology, including trauma, life-threatening bacterial sepsis, antiphospholipid antibody syndrome (APS), heparin-induced thrombocytopenia (HIT), chronic anticoagulant use, disseminated intravascular coagulation (DIC), and multiorgan failure [1,2,3,4]
We present a case of recurrent adrenal hemorrhage in a patient with antiphospholipid syndrome previously maintained on warfarin for deep vein thrombosis and pulmonary embolism prophylaxis who worsened shortly after transition to apixaban therapy
One such novel anticoagulating agent is apixaban, a direct factor Xa inhibitor approved by the Food and Drug Administration (FDA) in 2014 for the treatment of acute deep vein thromboses (DVT) and pulmonary embolisms (PE) in addition to risk the reduction of subsequent events, and apixaban is approved for anticoagulation in nonvalvular atrial fibrillation [17,18,19]
Summary
Adrenal hemorrhage presents a diverse yet potentially life-threatening family of injuries of variable etiology, including trauma, life-threatening bacterial sepsis, antiphospholipid antibody syndrome (APS), heparin-induced thrombocytopenia (HIT), chronic anticoagulant use, disseminated intravascular coagulation (DIC), and multiorgan failure [1,2,3,4]. One such novel anticoagulating agent is apixaban (trade name Eliquis®), a direct factor Xa inhibitor approved by the Food and Drug Administration (FDA) in 2014 for the treatment of acute deep vein thromboses (DVT) and pulmonary embolisms (PE) in addition to risk the reduction of subsequent events, and apixaban is approved for anticoagulation in nonvalvular atrial fibrillation [17,18,19]. This image was requested and completed by Mount Sinai Beth Israel, 2016
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