Apixaban-induced leukocytoclastic vasculitis

Abstract

Introduction: Drug-induced vasculitis is a rare adverse drug reaction and the potential to induce such a reaction is often established postmarketing. Leukocytoclastic vasculitis -a subtype of drug-induced vasculitis -often presents itself with palpable purpuric lesions, and often within weeks of initial administration. Case-description: We present a 62-year-old male who presented with leukocytoclastic vasculitis within the first 8 days of apixaban-initiation. Symptoms improved upon discontinuation and resolved after several months of prednisone therapy. Literature review: We conducted a search on PubMed, which yielded 10 reports of leukocytoclastic vasculitis induced by NOACs, of these 10 only 1 had been caused by apixaban, 4 caused by dabigatran and 5 had been caused by rivaroxaban. Of these cases, one presented with leukocytoclastic vasculitis induced by both rivaroxaban and dabigatran, and one case presented successful switch from apixaban to rivaroxaban. Conclusion: Apixaban-induced leukocytoclastic vasculitis is a rare but serious and important adverse reaction.

Hypersensitivity reaction to rivaroxaban with a successful switch to apixaban: A case report

“…Some reports have shown that discontinuing the DOAC without substitution (e.g., in cases of rivaroxaban‐induced leukocytoclastic vasculitis) has not resulted in negative clinical outcomes. 11 There are reports regarding switching from apixaban to warfarin in a case of cutaneous leukocytoclastic vasculitis, 12 anaphylactic reaction, 10 and acute generalized exanthematous pustulosis. 13 Moreover, several reports exist regarding the successful switch from rivaroxaban to low molecular weight heparin (LMWH) in the case of generalized rash 14 maculopapular erythematous and itchy rash, 15 and anaphylactic reaction.…”

Cutaneous collagenous vasculopathy in a middle‐aged woman with a history of prothrombin G20210A thrombophilia

“…Given that the patient was started on apixaban at the time of diagnosis of her prothrombin mutation, additional consideration must be given to the possible contribution of apixaban to the development of this patient's rash. Apixaban has been rarely reported to cause leukocytoclastic vasculitis, [6][7][8] as well as a psoriasiform rash. 9 In all of these cases, the patients' cutaneous symptoms arose within 1-2 weeks of starting apixaban.…”