open access

Vol 50, No 3 (2016)
Case reports
Submitted: 2015-11-22
Get Citation

Fatal consequences of climbing a ladder under apixaban and drunken

Claudia Stöllberger, Josef Finsterer
DOI: 10.1016/j.pjnns.2016.01.012
·
Neurol Neurochir Pol 2016;50(3):200-202.

open access

Vol 50, No 3 (2016)
Case reports
Submitted: 2015-11-22

Abstract

Background

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 description

In 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.

Conclusions

Patients 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

Background

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 description

In 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.

Conclusions

Patients 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.

Get Citation

Keywords

Anticoagulation, Apixaban, Atrial fibrillation, Cerebral hemorrhage

About this article
Title

Fatal consequences of climbing a ladder under apixaban and drunken

Journal

Neurologia i Neurochirurgia Polska

Issue

Vol 50, No 3 (2016)

Pages

200-202

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

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