open access
Fatal consequences of climbing a ladder under apixaban and drunken
Affiliations- Krankenanstalt Rudolfstiftung, Juchgasse 25, A-1030 Wien, Austria
open access
Abstract
Apixaban, a factor-Xa-inhibitor, is one of the non-vitamin-K-antagonist oral anticoagulants (NOACs) which are increasingly used in atrial fibrillation (AF). In real life even patients with contraindications to vitamin K antagonists (VKAs) receive NOAC because NOAC are considered as “safer” than VKAs.
Case descriptionIn a 61-years-old man with hypertension, heart failure and paroxysmal AF apixaban was started. Despite advices from his physicians, he continued alcohol abuse and suffered from recurrent falls. After 9 months he fell from a ladder and suffered from extensive subarachnoidal and intraparenchymal hemorrhages, subdural hematoma, brain edema with midline shift and a left-sided skull fracture. Because of the inability to reverse the anticoagulant therapy, no neurosurgical intervention was carried out and the patient died without regaining consciousness.
ConclusionsPatients with recurrent falls or chronic alcohol abuse should not be considered as candidates for NOACs. If anticoagulation is deemed necessary, VKA with its potential for prompt reversibility should be favored.
Abstract
Apixaban, a factor-Xa-inhibitor, is one of the non-vitamin-K-antagonist oral anticoagulants (NOACs) which are increasingly used in atrial fibrillation (AF). In real life even patients with contraindications to vitamin K antagonists (VKAs) receive NOAC because NOAC are considered as “safer” than VKAs.
Case descriptionIn a 61-years-old man with hypertension, heart failure and paroxysmal AF apixaban was started. Despite advices from his physicians, he continued alcohol abuse and suffered from recurrent falls. After 9 months he fell from a ladder and suffered from extensive subarachnoidal and intraparenchymal hemorrhages, subdural hematoma, brain edema with midline shift and a left-sided skull fracture. Because of the inability to reverse the anticoagulant therapy, no neurosurgical intervention was carried out and the patient died without regaining consciousness.
ConclusionsPatients with recurrent falls or chronic alcohol abuse should not be considered as candidates for NOACs. If anticoagulation is deemed necessary, VKA with its potential for prompt reversibility should be favored.
Keywords
Anticoagulation, Apixaban, Atrial fibrillation, Cerebral hemorrhage
About this articleTitle
Fatal consequences of climbing a ladder under apixaban and drunken
Journal
Neurologia i Neurochirurgia Polska
Issue
Pages
200-202
Page views
640
Article views/downloads
630
DOI
10.1016/j.pjnns.2016.01.012
Bibliographic record
Neurol Neurochir Pol 2016;50(3):200-202.
Keywords
Anticoagulation
Apixaban
Atrial fibrillation
Cerebral hemorrhage
Authors
Claudia Stöllberger
Josef Finsterer
