Atraumatic splenic rupture in a patient treated with apixaban: A case report

Yau, Ho-Cing Victor; Pradhan, Sharin; Mou, Lingjun

doi:10.1016/j.ijscr.2020.04.050

Cited by 8 publications

(6 citation statements)

References 15 publications

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“…PubMed and Google scholar were searched for cases of ASR related to DOACs with the keywords “rivaroxaban,” “apixaban,” “dabigatran,” “betrixaban,” “edoxaban,” and “splenic rupture.” Abstracts and full text written in French and English until June 2022 were included in our research. We found 13 cases in addition to ours 22–34 . The results are summarized in Table 3.…”

Section: Review Of the Literature On Atraumatic Splenic Rupturementioning

confidence: 51%

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Atraumatic splenic rupture in a patient treated with rivaroxaban: A case report and a narrative review

Labaki

Kock

2022

Clinical Case Reports

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Atraumatic splenic rupture (ASR) is a rare condition mostly associated with neoplastic, infectious, and inflammatory diseases. ASR associated with drug treatment is even rarer. In this case report, we highlight an unusual complication of the direct oral anticoagulant rivaroxaban. A 64‐year‐old male patient was admitted to the emergency department with complaints of faintness and diffuse abdominal cramps. The patient had no history of recent trauma. Clinical examination revealed hemodynamic instability with a moderate response to filling and mild abdominal discomfort on palpation. His medical history included chronic hypertension, constipation, and recent atrial flutter ablation. The patient was taking amiodarone, bisoprolol, atorvastatin, and rivaroxaban. Splenic rupture was diagnosed several hours later on contrast‐enhanced abdominal computed tomography scan. Massive blood transfusions and emergency laparotomy for splenectomy were performed. Anatomopathological analysis did not reveal any neoplastic, inflammatory, or infectious causes. The patient was successfully discharged from the intensive care unit 3 days later. Clinicians must consider the possibility of ASR as a complication of rivaroxaban in patients with abdominal tenderness and hemodynamic instability. Unfortunately, clinical presentation is not always typical of a ruptured spleen. Delayed diagnosis can be life threatening or fatal. Splenectomy via laparotomy remains the best therapeutic option in cases of splenic rupture in unstable patients on direct oral anticoagulants.

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Section: Review Of the Literature On Atraumatic Splenic Rupturementioning

confidence: 51%

“…We found 13 cases in addition to ours. [22][23][24][25][26][27][28][29][30][31][32][33][34] The results are summarized in Table 3.…”

Section: General Information About Rivaroxabanmentioning

confidence: 99%

Atraumatic splenic rupture in a patient treated with rivaroxaban: A case report and a narrative review

Labaki

Kock

2022

Clinical Case Reports

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“… 6 It has been hypothesized that anticoagulant use alters splenic hemostasis, thereby predisposing to microtrauma and reactive macrophage infiltration, with resultant splenic rupture. 8 , 9 Diagnostic delay, specifically in the setting of non-specific complaints, 5 , 8 – 10 and an oftentimes unremarkable physical examination has been noted to be one of the main contributors to mortality. 7 Atraumatic splenic rupture accounts for 3.2% of splenic ruptures as reported in one study, with approximately one-third of cases associated with anticoagulant use.…”

Section: Discussionmentioning

confidence: 99%

“… 5 , 6 , 11 One study found that up to 60% of patients undergoing embolization needed subsequent surgical intervention. 10 Another large systematic review by Renzulli et al found that 85.3% of atraumatic splenic rupture cases underwent surgical management with a marked improvement in mortality (7.4% vs. 14.7%) compared to non-operatively managed cases. 6 Furthermore, 17% of those initially managed medically required secondary operative intervention with a mortality rate of 4.4%.…”

Section: Discussionmentioning

confidence: 99%

Atraumatic Splenic Rupture on Direct Oral Anticoagulation

Barnes¹,

Alhaddad²,

Paz³

et al. 2022

Journal of Community Hospital Internal Medicine Perspectives

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“…In 2009, Renzulli et al published a systematic review that reported 926 cases of ASR and classified in six different categories ( Table 1 ) [3] . Previously, the absence of standardized nomenclature plus the rarity of the pathology led to a lack of high quality of evidence regarding patient characteristics and risk factors, incidence, etiology, outcomes, and crucially no guidelines to ease the clinical management [7] , [8] . Notwithstanding splenic artery embolization is an option for definitive therapy and it is described in literature [7] , [9] , splenectomy represents the most common choice in the clinical practice [3] , [8] .…”

Section: Discussionmentioning

confidence: 99%