apixaban / Generic mfg. - LARVOL DELTA

Apixaban in preventing portal vein thrombosis after laparoscopic splenectomy and azygoportal disconnection for cirrhosis: A single-arm trial. (PubMed, Surgery) - "Apixaban was associated with a lower risk of portal vein system thrombosis after laparoscopic splenectomy and azygoportal disconnection in cirrhotic patients compared with aspirin, suggesting its potential utility for prophylaxis in this population."

Journal • Cardiovascular • Fibrosis • Hematological Disorders • Immunology • Liver Cirrhosis • Portal Hypertension • Thrombosis

A Case of Drug-Induced Liver Injury Associated With Saw Palmetto. (PubMed, Cureus) - "A detailed medication history revealed over-the-counter SP use for approximately four months, discontinued two months before presentation, and a recent one-week course of trimethoprim-sulfamethoxazole for a urinary tract infection...Warfarin was reversed with vitamin K and transitioned to apixaban because of concern for potential hepatotoxicity. The patient was treated with ursodiol and cholestyramine, resulting in gradual improvement in liver enzymes and bilirubin, and was discharged with close hepatology and cardiology follow-up...Clinicians should routinely inquire about over-the-counter and herbal supplement use when evaluating unexplained liver injury. Increased awareness, comprehensive medication reconciliation, and improved regulation of dietary supplements may facilitate earlier recognition and reduce preventable hepatotoxicity."

Journal • Atrial Fibrillation • Benign Prostatic Hyperplasia • Cardiovascular • Chronic Obstructive Pulmonary Disease • Coronary Artery Disease • Dermatology • Hepatology • Hypertension • Immunology • Infectious Disease • Inflammation • Liver Failure • Nephrology • Pruritus • Pulmonary Disease • Respiratory Diseases

Stroke After Surgical Left Atrial Appendage Clip With Residual Neck Thrombus: Transcatheter Plug Closure. (PubMed, JACC Case Rep) - "Computed tomography and TEE should confirm exclusion before stopping anticoagulation after clip ligation. Plug occlusion performed with cerebral embolic protection can convert incomplete surgical exclusion to complete closure."

Journal • Atrial Fibrillation • Cardiovascular • Thrombosis

Perioperative Outcomes of Direct Oral Anticoagulant Use in Mohs Micrographic Surgery: A Propensity-Matched Analysis (EADV 2026) - "Patients undergoing MMS were stratified by perioperative DOAC use (apixaban, rivaroxaban, dabigatran, or edoxaban) versus no anticoagulant or antiplatelet therapy. Conclusions Perioperative DOAC use in MMS is associated with increased risks of bleeding, thromboembolic events, and healthcare utilization without increased infection risk. The rarity of mortality events underscores the overall short-term safety of MMS and supports individualized perioperative anticoagulation management."

Surgery • Cardiovascular • Hematological Disorders • Infectious Disease • Thrombosis

Masked polycythaemia vera presenting with extensive splanchnic venous thrombosis and mesenteric ischaemia. (PubMed, BMJ Case Rep) - "We report a woman in her 60s with masked PV who had been managed for 5 years with intermittent phlebotomy and aspirin without haematology referral, molecular testing or cytoreductive therapy...Therapeutic anticoagulation was initiated with enoxaparin and subsequently transitioned to apixaban, while hydroxyurea achieved sustained haematologic control...Given ongoing portal hypertension, oesophageal varices, occasional mild ostomy bleeding and low body weight, anticoagulation was continued indefinitely at reduced intensity with apixaban 2.5 mg twice daily. At 21-month follow-up, the patient remained free of recurrent thrombosis and major bleeding."

Journal • Cardiovascular • Gastroenterology • Gastrointestinal Disorder • Hematological Disorders • Hypertension • Polycythemia Vera • Portal Hypertension • Thrombosis • Venous Thromboembolism • JAK2

ENOXAPARIN INDUCED BULLOUS HEMORRHAGIC DERMATOSIS: RARE BUT NOT TO BE FORGOTTEN ENTITY (EADV 2026) - "Enoxaparin was discontinued and replaced with apixaban. This case emphasizes the need for clinicians to recognize this rare condition, ensure careful drug history, and differentiate it from bullous pemphigoid, bullous vasculitis, epidermolysis bullosa acquisita, and heparin-induced skin necrosis. Management requires stopping heparin or its analogues and switching to an anticoagulant with a different mechanism of action."

Alopecia • Atopic Dermatitis • Bullous Pemphigoid • Cardiovascular • Cervical Cancer • Contact Dermatitis • Dermatitis • Dermatology • Dermatopathology • Hematological Disorders • Immunology • Myocardial Infarction • Osteoporosis • Pulmonary Disease • Solid Tumor • Thrombocytopenia • Urticaria • Vasculitis • Venous Thromboembolism

Pemphigoid-like bullous drug eruption associated with rivaroxaban: A case report (EADV 2026) - "Case Presentation A 76-year-old female patient with a history of hypertension treated with ramipril and acetylsalicylic acid and two previous cardioembolic ischemic strokes in 2021 and 2023, after which treatment was modified by the introduction of rivaroxaban and rosuvastatin, presented with a pruritic bullous skin eruption that appeared two months after initiation of the new medications, with preserved general condition...Management consisted of initiating topical therapy with very potent corticosteroids using clobetasol propionate 0.05% cream at an initial dose of 30 g/day with gradual tapering, combined with withdrawal of the suspected drug, rivaroxaban, which was replaced by apixaban in consultation with the cardiologist...The compatible temporal relationship, rapid improvement after rivaroxaban withdrawal, and absence of recurrence after more than one year support the probable involvement of rivaroxaban. This case underlines the need to consider pemphigoid-like..."

Case report • Clinical • Bullous Pemphigoid • Cardiovascular • Dermatopathology • Hypertension • Immunology • Ischemic stroke • Urticaria

Secondary amino groups in ACE inhibitors/ Calcium Channel Blockers, Antiarrhythmics and Anticoagulants as donors for drug related phototoxicity/ carcinogenicity: the completely new role of the Nutritional nitrosogenesis as substantial additional cofactor for skin carcinogenesis (EADV 2026) - "Results We present another case of keratinocyte cancer (basal cell carcinoma) (Figure a) that developed relatively shortly after combined intake of four drugs (apixaban, flecainide, amlodipine, and perindopril), each containing a secondary amino group in its structure - serving as a potential precursor for the generation of photocarcinogens in the stomach. Conclusions The role of endogenous gastric related Nitrosogenesis during the intake of potentially /completely uncontaminated drugs - particularly those containing secondary amino groups - in relation to nitroso-photocacinogenesis and subsequent development of skin cancer is considered. This perspective introduces a novel conceptual framework: even in the absence of exogenous nitrosamine contamination, endogenous nitrosamine formation prior to hepatic metabolism may represent a critical, previously underrecognized step in the pathway of nitrosocarcinogenesis."

Basal Cell Carcinoma • Genetic Disorders • Non-melanoma Skin Cancer • Oncology • Skin Cancer

Melanoma development and progression during polypharmacy and the additional intake of metformin and sitagliptin: links to nitroso photocarcinogenesis and oncopharmacogenesis (EADV 2026) - "Results We present 3 cases of patients with melanomas of the skin that developed and progressed in the context of intake of secondary/tertiary amino groups: (1) Patient 1's regimen during the years included bisoprolol (secondary), nebivolol (secondary), candesartan /hydrochlorothiazide (secondary), amlodipine (secondary), and clopidogrel (tertiary), and esomeprazole (tertiary) [Figure a,b]; (2) Patient 2's included amiodarone (tertiary), apixaban, furosemide (secondary), spironolacton, and pantoprazole (tertiary) [Figure c,d]; and (3) Patient's 3 regimen included sitagliptin (secondary)/metformin (secondary and tertiary), glimepiride (secondary), and gliclazide (tertiary) [Figure e,f]. The primary defects were closed with single interrupted sutures (f). Conclusions We comment on the possible relevance of endogenous Nitroso formation in the drugs mentioned above in relation to melanoma pathogenesis."

Biomarker • Genetic Disorders • Melanoma • Oncology • Solid Tumor

Balancing thrombotic risk and therapeutic benefit: baricitinib for severe atopic dermatitis in a patient with systemic lupus erythematosus and prior thromboembolism (EADV 2026) - "His previous SLE treatment included systemic corticosteroids, chloroquine, cyclophosphamide, and methotrexate. During the 2010s, he developed deep vein thrombosis and inferior vena cava thrombosis, requiring long-term anticoagulant therapy with low-molecular-weight heparin, later switched to apixaban in 2017...Since 2011, the patient had experienced recurrent intensely pruritic eczematous lesions predominantly involving the dorsal hands, forearms, trunk, and lower legs, partially responsive to topical corticosteroids and tacrolimus ointment, but with frequent relapses...Despite treatment interruption, no significant flare or worsening of AD occurred. Conclusion This case highlights the successful use of baricitinib for severe AD in a patient with SLE and a history of inferior vena cava thrombosis and deep vein thrombosis, emphasizing the importance of individualized therapeutic decision-making and multidisciplinary management."

Clinical • Atopic Dermatitis • Cardiovascular • Dermatitis • Dermatology • Dyslipidemia • Eosinophilia • Food Hypersensitivity • Glomerulonephritis • Hematological Disorders • Immunology • Infectious Disease • Inflammatory Arthritis • Influenza • Lupus • Lupus Nephritis • Metabolic Disorders • Nephrology • Pneumonia • Pruritus • Respiratory Diseases • Systemic Lupus Erythematosus • Venous Thromboembolism

Evaluating the Impact of Therapeutic Anticoagulation Management in Head and Neck Free Tissue Transfer: A Retrospective Study of 126 Cases. (PubMed, Microsurgery) - "This study highlights the challenges of managing therapeutic anticoagulation in head and neck free flap surgery, where thromboembolic risk during interruption and hemorrhagic complications upon resumption point to the need for clearer guidelines. Evidence-based protocols are needed to replace discretionary practices and improve outcomes."

Journal • Retrospective data • Atrial Fibrillation • Cardiovascular • Hematological Disorders • Otorhinolaryngology • Venous Thromboembolism

Peripheral Nerve Stimulation for Refractory Hip Osteoarthritis in a Medically Complex Patient: A Case Report (ASA 2026) - "His history included heart failure with reduced ejection fraction (30%), pulmonary hypertension, and chronic atrial fibrillation on apixaban. Pain-related disability persisted despite >6 months of conservative therapy, including physical therapy, medication management (including opioids), and intra-articular steroid injection, which provided only transient relief. After a successful peripheral nerve stimulation (PNS) trial with >80% improvement, permanent femoral and obturator nerve PNS implantation was performed under monitored anesthesia care without complication."

Case report • Clinical • Atrial Fibrillation • Cardiovascular • Congestive Heart Failure • Heart Failure • Immunology • Osteoarthritis • Pulmonary Arterial Hypertension • Pulmonary Disease • Respiratory Diseases • Rheumatology

Acute LAD Thrombosis During TAVR Detected by Intraoperative Monitoring Before Valve Deployment (ASA 2026) - "A 73-year-old female with severe aortic stenosis and atrial fibrillation (CHA₂DS₂-VASc 8, apixaban held 72 hours) underwent transfemoral TAVR under general anesthesia...The patient developed transient ventricular fibrillation post-reperfusion but recovered and was discharged. TAVR was successfully completed three months later."

Atrial Fibrillation • Cardiovascular • Hematological Disorders • Thrombosis

A Fragile Right Ventricle: A Case of LVAD Implantation and Early Device Thrombosis (ASA 2026) - "A 38-year-old male with a history of nonischemic cardiomyopathy, HFrEF and prior LV thrombus on apixaban presented with acute decompensation of heart failure...1-week post-implantation, he developed device and outflow graft thromboses despite being on warfarin therapy, which necessitated urgent LVAD replacement. The patient recovered appropriately. This case highlights both hemodynamic management of cardiogenic shock and anticoagulation management in regard to device implantation."

Clinical • Cardiomyopathy • Cardiovascular • Congestive Heart Failure • Heart Failure • Hematological Disorders • Thrombosis

Preoperative Assessment of Cardiac Anatomy and Function, and Intraoperative Airway Management in a Complex Case (ASA 2026) - "Her past medical history includes situs inversus, transposition of the great arteries, s/p Mustard atrial switch, stenting of the SVC limb, and biventricular ICD for SSS, CHB and V. fib., h/o traumatic difficult intubation with cardiac arrest, and a prior embolic stroke, currently on apixaban. Key challenges include the surgeon's request for THRIVE and apnea oxygenation, and the preoperative POCUS assessment given her complex anatomy from situs inversus and transposition of the great arteries."

Clinical • Cardiovascular • Ischemic stroke • Pulmonary Disease

Management of Elective Hip Arthroplasty in a Patient with Autoimmune Necrotizing Myopathy (ASA 2026) - "We describe a patient with IMNM complicated by NICM with HFrEF (35-40%), persistent atrial fibrillation on apixaban, OSA, prior VT status post ICD placement, and previous cardiac arrest who presented for elective left total hip arthroplasty. The procedure was successfully completed with CSE and arterial line monitoring. This case highlights neuraxial anesthesia as a valuable strategy in patients with IMNM when evidence-based perioperative guidance remains scarce."

Clinical • Atrial Fibrillation • Cardiovascular • Immunology • Myositis • Orthopedics • Respiratory Diseases

Balancing Cardiopulmonary Disease, Anticoagulation, and Neuraxial Techniques: Perioperative Anesthetic Management for Hip Fracture in a Frail Geriatric Patient (ASA 2026) - "An 87‑year‑old female with severe cardiopulmonary disease, atrial fibrillation on apixaban, and a femoral neck fracture required urgent hip hemiarthroplasty...On the morning of surgery, overnight enoxaparin dosing prompted coagulation assessment with TEG and INR prior to proceeding with an intrathecal catheter and sedation. Postoperative lower‑extremity neurological deficits triggered evaluation for neuraxial hematoma, ultimately attributed to deconditioning. This case highlights nuanced decision‑making in regional anesthesia for high‑risk geriatric patients."

Clinical • Atrial Fibrillation • Cardiovascular • Geriatric Disorders • Musculoskeletal Diseases • Orthopedics • Respiratory Diseases

Low-Dose Epidural Anesthesia for Orchiectomy in Severe Pulmonary Hypertension and Reduced Ejection Fraction (ASA 2026) - "However, careful titration is crucial to prevent systemic hypotension. We present an 85-year-old man with severe PH, reduced EF, atrial fibrillation on apixaban, SVC occlusion, and chronic respiratory failure who successfully underwent orchiectomy under low-dose lumbar epidural anesthesia."

Atrial Fibrillation • Cardiovascular • CNS Disorders • Congestive Heart Failure • Depression • Heart Failure • Hypotension • Pulmonary Arterial Hypertension • Pulmonary Disease • Respiratory Diseases

Severe Hypertriglyceridemia as a Novel Adverse Effect of Enoxaparin in a Postoperative Adolescent (ASA 2026) - "Enoxaparin was discontinued and replaced with apixaban; triglycerides normalized over several weeks. Two prior reports document similar reactions to unfractionated heparin, but to our knowledge, we describe the first such adverse reaction to LMWH, which necessitates prompt recognition to prevent serious perioperative complications."

Adverse events • Dyslipidemia • Hypertriglyceridemia • Immunology • Severe Hypertriglyceridemia

Pheo-nomenal Challenges: Anesthetic Management of Adrenalectomy for Pheochromocytoma (ASA 2026) - "The patient described is a 79 year old female, with history of PE on Eliquis, DM II, HTN, and right sided pheochromocytoma with metastases to the retroperitoneal lymph nodes...Intraoperatively, the patient experienced wide hemodynamic swings, prompting concern for unoptimized pheochromocytoma. Anesthetic management is described."

Solid Tumor

Sudden Hemodynamic Collapse During Pulsed Field Ablation Revealing Acute Multivessel Coronary Thrombosis (ASA 2026) - "We report a 73-year-old man undergoing pulsed field ablation on uninterrupted apixaban who developed abrupt hemodynamic collapse marked by a sudden decline in end-tidal CO₂, hypotension, and diffuse ST-segment elevation...Mechanical thrombectomy restored TIMI III flow with rapid physiologic recovery. This case highlights abrupt capnographic decline as an early indicator of circulatory collapse requiring immediate recognition and intervention."

Atrial Fibrillation • Cardiovascular • Heart Failure • Hematological Disorders • Hypotension • Thrombosis

Cowden Syndrome and Difficult Airway Management with Awake Fiberoptic Intubation (ASA 2026) - "A 56-year-old male with Cowden syndrome and friable oropharyngeal hamartomas, atrial fibrillation on apixaban with recurrent hemoptysis, multinodular goiter, and obstructive sleep apnea on nocturnal BiPAP presented for cholecystectomy for gangrenous cholecystitis. An awake transnasal fiberoptic intubation using nebulized tranexamic acid and topical lidocaine was successfully performed. We present a multifactorial difficult airway requiring an atraumatic, coordinated approach, highlighting the importance of multidisciplinary collaboration with otolaryngology for contingency airway planning to ensure safe airway control."

Intubation • Atrial Fibrillation • Cardiovascular • Endocrine Disorders • Gastroenterology • Hepatology • Obstructive Sleep Apnea • Otorhinolaryngology • Rare Diseases • Respiratory Diseases • Sleep Disorder

Balancing Hemorrhage and Thrombosis: FEIBA Use in a Polytrauma Patient with Acute HIT (ASA 2026) - "Management required strict heparin avoidance, temporary interruption and reversal of argatroban and apixaban, invasive hemodynamic monitoring, vasopressor support, blood transfusion, and urgent administration of FEIBA as a heparin-free prohemostatic agent to reverse apixaban. Following hemostasis, antithrombotic therapy was carefully reinitiated to minimize the risk of stent thrombosis. This case highlights the anesthetic challenge of balancing catastrophic hemorrhage and extreme thrombotic risk in acute HIT, while emphasizing FEIBA (Anti-inhibitor coagulant complex) as an underrecognized reversal option."

Clinical • Cardiovascular • Hematological Disorders • Thrombosis

Septal Myectomy Complicated by Muscle Embolism to Left Main Coronary Artery (ASA 2026) - "72F hx HTN, Afib on Eliquis, carotid stenosis, HOCM presented for septal myectomy. After two pump runs, she developed severe biventricular failure requiring VA ECMO. Ultimately, she was found to have a distal LM occlusion from muscle embolism and underwent successful aspiration thrombectomy."

Obstructive Hypertrophic Cardiomyopathy

Combined Heart-Liver Transplantation in Failing Fontan Physiology (ASA 2026) - "47-year-old F with PMHx significant for double inlet left ventricle s/p non-fenestrated lateral tunnel Fontan on Eliquis and failing Fontan physiology presented for a combined heart and liver transplant...Significant anesthetic challenges involved passive pulmonary blood flow, chronic venous hypertension, and Fontan-associated liver disease. Here we discuss management strategies including optimization of pulmonary vascular resistance, post-CPB augmentation of RV function, viscoelastic-guided coagulation management, continuous TEE monitoring, and multidisciplinary coordination."

Cardiovascular • Fibrosis • Heart Failure • Hepatology • Hypertension • Immunology • Solid Organ Transplantation • Transplantation