Spontaneous Spleen Rupture and Apixaban

Year 2020, Volume: 11 Issue: 2, 47 - 48, 09.10.2020

Birdal Yıldırım , Ethem Acar , Ahmet Demir Kemal Gökçek Ahmet Aksakal Özcan Başaran

https://doi.org/10.33706/jemcr.692709

Abstract

Novel oral anticoagulants (NOACs) are now widely used. Spontaneous splenic rupture (SLR) is a rare condition. It is life-threatening, especially if not immediately recognized. Previous studies have shown an association between NOAC use and SLR. We report a case of a 53-year-old female patient who responded to cardiopulmonary resuscitation (CPR) after SLR. The patient, who had an external cardiac device for heart failure 13 months ago was admitted to our emergency department. She was unconscious, pale, hypotensive and had tachycardia. Free fluid was detected in the peritoneum by bedside ultrasonography. The patient was resuscitated for 20 minutes after arrest during the follow-up period. She was stabilized and computed tomography showed a large subcapsular splenic hematoma with active extravasation around the spleen, but persistent low urine output developed with hypotension despite resuscitation. She was taken to the operating room for splenectomy and abdominal washing. She was then recovered and discharged 17 days later. We wanted to draw attention to a patient with SLR due to NOACs. Rapid diagnosis and aggressive early resuscitation are critical in the management of NOAC associated SLR.

Keywords

Resuscitation, NOAC

References

• 1.Khan RN, Jindal V. Systematic review of atraumatic splenic rupture. British Journal of Surgery. Br J Surg. 2010 Apr;97(4):616; author reply 616-7. doi: 10.1002/bjs.7052.
• 2.Kimura M, Hoshina K, Kobayashi M, Yamamoto S, Ohshima M, Watanabe T. Morphological analysis using geometric parameters for splenic aneurysms. Asian Cardiovasc Thorac Ann. 2018 Feb;26(2):133-138. doi: 10.1177/0218492318757040. Epub 2018 Jan 24.
• 3. Vanassche T, Hirsh J, Eikelboom JW, Ginsberg JS. Organ-specific bleeding patterns of anticoagulant therapy: lessons from clinical trials. Thromb Haemost. 2014;112(5):918-23.
• 4. Khateeb D, Santarelli R, Wexler P, Young D. Hemorrhagic Shock Due To Spontaneous Splenic Rupture: A Rare Complication Of Babesiosis. Crit Car Med. 2019;47(1):300.
• 5. Azar F1, Brownson E, Dechert T. Cocaine-associated hemoperitoneum following atraumatic splenic rupture: a case report and literature review. World J Emerg Surg. 2013 Aug 28;8(1):33. doi: 10.1186/1749-7922-8-33.
• 6. Nagaraja V, Cranney G, Kushwaha V. Hemorrhagic Shock from Spontaneous splenic rupture due to rivaroxaban. BMJ Case Rep. 2018 Mar 5;2018. pii: bcr-2017-223237. doi: 10.1136/bcr-2017-223237.
• 7. Abdelhady A, Ahmed A, Mohamed Y, Binchy J. Apixaban-Associated Spontaneous Splenic Rupture-A Case Report. Ir Med J. 2018 Aug 13;111(7):792
• 8. Crabol Y, Terrier B, Rozenberg F, Pestre V, Legendre C, Hermine O, Montagnier-Petrissans C, Guillevin L, Mouthon L; Groupe d'experts de l'Assistance Publique-Hôpitaux de Paris. Intravenous immunoglobulin therapy for pure red cell aplasia related to human parvovirus b19 infection: a retrospective study of 10 patients and review of the literature. Clin Infect Dis. 2013 Apr;56(7):968-77. doi: 10.1093/cid/cis1046. Epub 2012 Dec 12.
• 9. Carta G1, D'Alfonso A, Nallbani A, Palermo P, Franchi V, Patacchiola F. Spontaneous rupture of splenic hemangioma in puerperium. Clin Exp Obstet Gynecol. 2012;39(3):407-8.
• 10. Gonzva J, Patricelli R, Lignac D. Spontaneous splenic rupture in a patient treated with rivaroxaban. Am J Emerg Med. 2014;32(950):e3.
• 11. Alexander Janke, Suzette Ikejiani, Charles Mize. Spontaneous splenic hemorrhage in a patient on apixiban. December 19, 2019DOI:https://doi.org/10.1016/j.ajem.2019.12.006