apixaban / Generic mfg. - LARVOL DELTA

Anticoagulation in Atrial Fibrillation: Is a Paradigm Shift From Xa to XIa Inhibitors on the Horizon? (PubMed, Cardiol Rev) - "The effective management of atrial fibrillation, particularly regarding the prevention of ischemic stroke and systemic embolism, has progressed with the introduction of direct oral anticoagulants, which have shown a reduction in bleeding risks when compared to warfarin. The oral factor Xa inhibitors, such as apixaban and rivaroxaban, are considered the first line for anticoagulation in cases of atrial fibrillation. Several factor XI inhibitors, including abelacimab, asundexian, osocimab, gruticibart, milvexian, and fesomersen, are currently undergoing clinical trials for similar therapeutic purposes...This review article aims to emphasize the recent trials evaluating these factor XI inhibitors with a special focus on abelacimab. Abelacimab may signify a promising advancement in anticoagulation therapy, providing potential advantages such as reduced gastrointestinal bleeding risks and the convenience of monthly dosing."

Journal • Atrial Fibrillation • Cardiovascular • Gastroenterology • Ischemic stroke

Venous sinus thrombosis leading to seizures in a patient with Crohn's disease on Remicade (EULAR 2025) - "She managed with a heparin drip and transitioned to Eliquis 5 mg BID...She has a history of seizures of unknown etiology, for which she was on Keppra 1000 mg BID...No known vascular conditions were identified. The patient’s fibrinogen levels were not tested, but factors such as elevated fibrinogen, Factor V, and Factor VIII are known in inflammatory bowel disease."

Clinical • Ankylosing Spondylitis • Cardiovascular • CNS Disorders • Crohn's disease • Epilepsy • Gastroenterology • Gastrointestinal Disorder • Hematological Disorders • Human Immunodeficiency Virus • Immunology • Infectious Disease • Inflammatory Arthritis • Inflammatory Bowel Disease • Pain • Rheumatology • Seronegative Spondyloarthropathies • Thrombosis

Guideline Directed Anticoagulant Treatment and Dosing in a Contemporary Atrial Fibrillation Cohort: Analysis of the TRANSECT-AF Program. (PubMed, CJC Open) - "Older age, lower body mass index, female sex, lower renal function, higher thromboembolic risk and non-apixaban DOAC use were independently associated with discordant dosing. Within this Canadian AF registry, 11% of patients were on NGDT and 32% of patients on GDT with a DOAC were treated with a guideline-discordant dose. Our analysis describes predictors of guideline discordant anticoagulation and DOAC dosing that may be used to identify target populations for future quality improvement initiatives in AF thromboprophylaxis."

Journal • Atrial Fibrillation • Cardiovascular

Recurrent thrombosis despite oral anticoagulation? A case report (PubMed, Praxis (Bern 1994)) - "We describe a 34-year-old female patient with recurrent thromboembolic events, most recently with occlusion of the superior mesenteric vein - despite regular intake of oral anticoagulation with Apixaban at the dosage recommended by the manufacturer. The underlying cause was enteral malabsorption with protein loss syndrome due to active Crohn's disease, limited to the small intestine, with an atypical clinical presentation. We discuss the topic of anticoagulation in the presence of an enteral barrier disorder."

Journal • Cardiovascular • Crohn's disease • Gastroenterology • Hematological Disorders • Immunology • Inflammatory Bowel Disease • Thrombosis

Weekly Journal Scan: Extending anticoagulation beyond 6 months after venous thromboembolism in patients with active cancer. Is low-dose apixaban the answer? (PubMed, Eur Heart J) - No abstract available

Journal • Cardiovascular • Oncology • Venous Thromboembolism

Newly identified cerebral microbleeds in patients on anticoagulation for secondary stroke prevention. (PubMed, Medicine (Baltimore)) - "Patients with cardioembolic ischemic stroke are commonly prescribed direct oral anticoagulants (DOACs), such as dabigatran (a direct thrombin inhibitor) and factor Xa inhibitors (e.g., apixaban and rivaroxaban), or warfarin to reduce the risk of recurrent stroke. Over 1 year of anticoagulant therapy, new MBs were detected in 10.1% of patients, predominantly in lobar and infratentorial regions. No differences in the incidence of new MBs were identified between the different anticoagulant groups."

Journal • Observational data • Cardiovascular • Cerebral Hemorrhage • Hematological Disorders • Ischemic stroke

Management and Outcomes of Intracranial Hemorrhage in Atrial Fibrillation Patients: Highlighting Practices in Saudi Arabia. (PubMed, Cureus) - "Our findings revealed that ICH in Afib patients is associated with high mortality and overall poor prognosis. There is a clear need for standardized management guidelines. Further studies are essential to establish evidence-based recommendations and reach reliable conclusions to improve patient outcomes."

Journal • Atrial Fibrillation • Cardiovascular • Cerebral Hemorrhage • CNS Disorders • Diabetes • Hematological Disorders • Ischemic stroke • Metabolic Disorders

Pulmonary Thromboembolism at High Altitude in a Previously Healthy Adult: A Case Report. (PubMed, Cureus) - "Treatment with apixaban led to symptomatic improvement, and the patient was discharged in stable condition. This case highlights the need to consider pulmonary thromboembolism in the differential diagnosis of respiratory distress at high altitude, where hypoxia and other altitude-related factors may contribute to a hypercoagulable state."

Journal • Cardiovascular • Hematological Disorders • Pulmonary Embolism • Respiratory Diseases

The Puzzle Pieces of Right-sided Heart Failure: Unraveling Its Many Faces (ATS 2025) - "A 53-year-old male with a complex cardiac history presented with persistent lower extremity edema and orthopnea unresponsive to increased Lasix. His history includes cardiac arrest, heart failure with reduced ejection fraction (EF 20-25%) due to ischemic cardiomyopathy, treated with a dual-chamber pacemaker and defibrillator, coronary artery disease with drug-eluting stents, paroxysmal atrial fibrillation on Eliquis, recurrent ventricular tachycardia post-trans-catheter ablations, hypertension, hyperlipidemia, and type 2 diabetes...Our case presents RV Failure secondary to multiple etiologies: Cardiac contusion secondary to CPR, cardiac tamponade and intra-atrial shunt. The advances in the field of Interventional Cardiology allow us to treat all these reversible causes via a minimally invasive approach in an otherwise complex patient and achieve the best outcome for the patient."

Atrial Fibrillation • Cardiomyopathy • Cardiovascular • Congestive Heart Failure • Coronary Artery Disease • Diabetes • Dyslipidemia • Heart Failure • Hypertension • Inflammation • Metabolic Disorders • Pulmonary Embolism • Respiratory Diseases • Type 2 Diabetes Mellitus • Ventricular Tachycardia

To Drain or Not to Drain the Liquefactive Omentum (ATS 2025) - "Case description: The patient was a 64 year old female with a history of hypercoagulable disorder on eliquis who presented in septic shock with a 16 cm omental infarction after previous extensive abdominal surgery which had since become liquefactive...Repeat CT on day 8 showed improvement in size of the infarction (3 x 2 cm) and the patient was discharged on lower doses of midodrine and oral antibiotics...Given ongoing discolored fluid drainage throughout her hospitalization, her drain was maintained until outpatient follow-up and repeat CT. While not clear if drainage of the fluid provided a benefit not achieved by antibiotics alone, as the patient required vasopressor support before and after the procedure, it would be beneficial to study the use of IR-guided drain placement in patients with liquefactive omental infarction with or without abscess as it may decrease hospital length or need for vasopressor support."

Hematological Disorders • Hypotension • Infectious Disease • Metabolic Disorders • Septic Shock

Hemodynamic Collapse in Acute Pancreatitis: Diagnostic Workup Leading to Discovery of Pancreatic Adenocarcinoma and Splenic Rupture (ATS 2025) - "Past medical history included hypertension, type II diabetes, and atrial fibrillation (A-fib) on Apixaban...She recovered from her pancreatitis and is currently receiving chemotherapy for her cancer. Clinicians should consider ASR in the differential diagnosis for patients with AP who experience hemoglobin drops, facilitating timely recognition and improved outcomes."

Atrial Fibrillation • Cardiovascular • Diabetes • Dyslipidemia • Endocrine Disorders • Gastroenterology • Gastrointestinal Disorder • Hypertension • Hypertriglyceridemia • Oncology • Pain • Pancreatic Adenocarcinoma • Pancreatic Cancer • Pancreatitis • Thrombosis • Type 2 Diabetes Mellitus

Double Trouble Heartbreak (ATS 2025) - "His anticoagulation was switched to heparin drip and subsequently argatroban due to Eliquis failure. A cardiac MRI may have better delineated the type of lesion that truly existed on the aortic valve. Regardless, the patient was a poor surgical candidate for repair of either lesion."

Cardiovascular • Diabetes • Gastroenterology • Hepatology • Metabolic Disorders • Oncology • Pain • Pancreatic Adenocarcinoma • Pancreatic Cancer • Respiratory Diseases • Venous Thromboembolism

A Fatal Complication After Prophylactic Anticoagulation for COVID-19 in a Lung Transplant Recipient (ATS 2025) - "We describe a lung transplant recipient who developed RSH following prophylactic enoxaparin administration for COVID-19 treatment. Description: 78-year-old man with a significant medical history including bilateral lung transplantation two years prior due to chronic obstructive pulmonary disease (COPD), maintained on an immunosuppressive regimen of tacrolimus, mycophenolate mofetil, and prednisone presented to the emergency department with fever, severe headaches, and myalgias...He was initiated on a treatment regimen including high-dose steroids, remdesivir, monoclonal antibodies (casirivimab and imdevimab), and apixaban for thromboembolism prophylaxis...In the context of COVID-19, where anticoagulation is frequently indicated, awareness of RSH's potential is essential. While most RSH cases can be managed conservatively or via angiographic intervention, this case highlights the increased mortality risk associated with RSH in patients suffering from COVID-19."

Clinical • Cardiovascular • Chronic Obstructive Pulmonary Disease • Immunology • Infectious Disease • Musculoskeletal Pain • Novel Coronavirus Disease • Pain • Pneumonia • Pulmonary Disease • Respiratory Diseases • Transplantation

A Case of Cardiac Tamponade Following Catheter Ablation for Atrial Fibrillation While on Continuous Anticoagulation (ATS 2025) - "Case: 72-year-old female with AF status post pulmonary vein isolation with cavotricuspid isthmus ablation 3 weeks before admission currently on apixaban and bilateral metastatic renal cell carcinoma status post nephrectomy and adjuvant chemotherapy in remission presented with chest pain and dyspnea...Emergent drainage should be performed while stopping the patient's DOAC and transitioning to an easily reversible anticoagulant, such as a heparin drip following stabilization. This case highlights the importance of prompt recognition for patients presenting tamponade post-procedure in order to provide appropriate care and avoid disastrous complications."

Clinical • Atrial Fibrillation • Cardiovascular • Genito-urinary Cancer • Immunology • Oncology • Pain • Pulmonary Disease • Renal Cell Carcinoma • Solid Tumor

Rare Non-malignant Case Of Recurrent SVC Syndrome Caused By Cardiac Pacer Wires And Vessel Fibrosis From ESRD (ATS 2025) - "He underwent an angioplasty of the SVC and left sided central vein and was placed on oral anticoagulation (Apixaban)...Secondly this is a case of recurrent SVC syndrome status post angioplasty whilst on anticoagulation nonetheless. It certainly begs the question in future recurrent SVC cases if anticoagulation plus anti-platelet therapy or if a non-reduced dose of an anticoagulation should be an option."

Clinical • Chronic Kidney Disease • CNS Disorders • Fibrosis • Immunology • Oncology • Renal Disease • Solid Tumor • Thrombosis

Caught Adrift Navigating the Incidental Discovery of a Floating Aortic Thrombus (ATS 2025) - "She received immediate intravenous heparin, which was later transitioned to apixaban for long-term anticoagulation. Prompt anticoagulation and coordinated multidisciplinary care can lead to successful outcomes. Additionally, the case highlights the role of genetic screening in patients with atypical thrombotic events, as identifying inherited thromboembolic disorders influences patient care and offers valuable insights for genetic screening and family counseling."

CNS Disorders • Coronary Artery Disease • Epilepsy • Hematological Disorders • Myocardial Infarction • Pulmonary Embolism • Thrombosis

"I Can't (PE)e": Dual Etiologies of Obstructive Shock in a Single Patient (ATS 2025) - "The patient was empirically anticoagulated with intravenous heparin, and a CT angiogram of the chest confirmed a saddle pulmonary embolism (PE)...He was subsequently placed on a three-month course of apixaban for provoked PE...To our knowledge, this is the first report of both obstructive mechanisms occurring sequentially within the same patient. Given that acute urinary retention affects approximately 10% of males over age 70, it is essential to consider bladder distension as a potential cause of obstructive shock, particularly when more common causes have been excluded."

Clinical • Cardiovascular • Constipation • Gastroenterology • Gastrointestinal Disorder • Hematological Disorders • Hypotension • Pain • Pulmonary Embolism • Respiratory Diseases • Venous Ulcer

A Case of Extensive Pulmonary Emboli With Additional Thrombus Extending Into Left Atrium From a Patent Foramen Ovale (ATS 2025) - "Description: A 62-year-old female with a history of hypothyroidism, obstructive sleep apnea, a prior deep venous thrombosis following shoulder surgery (completed 3-months of eliquis therapy) and a left knee replacement 13 days prior to presentation (on daily 81mg aspirin), presented to the hospital after a sudden loss of consciousness during an outpatient physical therapy session...Her postoperative course was significant for the brief use of norepinephrine and dobutamine therapy, and initiation of amiodarone for ectopic beat suppression... PE with a thrombus extending through a PFO into the left atrium on CTA is quite a rare presentation and it requires immediate interventions because of hemodynamic compromise, and also due to the risk of systemic embolization which may lead to critical consequences. Furthermore, given such a rare presentation, radiologists and treating physicians need to be aware of the possibility of clot migration through a PFO."

Clinical • Cardiovascular • Endocrine Disorders • Hematological Disorders • Musculoskeletal Diseases • Obstructive Sleep Apnea • Orthopedics • Pulmonary Embolism • Respiratory Diseases • Sleep Disorder • Thrombosis

Case of Lower Extremity Deep Vein Thrombosis with Negative D-Dimer in a Patient with High Well's Score (ATS 2025) - "The patient was subsequently started on apixaban...Clinicians should have high index of suspicion in patients with negative D-dimer and clinical signs of DVT specially if they have a high Well's score. Bedside 3-point ultrasound could be very helpful in ruling out DVT in patients with high suspicion."

Clinical • Cardiovascular • Fragile X Syndrome • Genetic Disorders • Oncology • Pain • Thrombosis • Venous Thromboembolism

Persistent Thrombocytopenia as a Sign of Perioperative VTE in a Lung Transplant Recipient (ATS 2025) - "2022) showed 50% stenosis of the left anterior descending artery and severe ectasia related to endothelial dysfunction of all coronaries, managed with warfarin...He was treated with therapeutic enoxaparin sodium and transitioned to apixaban 5 mg BID for 7 days for anti-coagulation, then 2.5 mg BID; an inferior vena cava filter was placed, given the need to suspend anticoagulation for procedures during the first year after transplant...Coronary ectasia in our patient was managed with an anticoagulant (clopidogrel deferred in lieu of apixaban), aspirin, and a statin. Thrombocytopenia was the initial sign of recurrent VTE in our patient emphasizing the importance of monitoring hematologic parameters in these individuals."

Clinical • Cardiovascular • Hematological Disorders • Immunology • Pulmonary Disease • Respiratory Diseases • Thrombocytopenia • Transplantation • Venous Thromboembolism

When Too Much Anticoagulation Becomes Hazardous: A Case Report of Massive Apixaban Overdose (ATS 2025) - "Unlike warfarin does not require any biological monitoring thanks ease of use...Diuresis with furosemide was attempted but oxygen requirements did not improve. At this time there was a high suspicion for TRALI but given patient and family wishes, he was transitioned to comfort and expired.Management of toxicity regards to DOAC such as rivaroxaban and apixaban were largely based on the ANNEXA trials...Studies comparing prothrombin complex concentrate and Andexanet showed similar clinical outcomes in terms of mortality and anticoagulation reversal. There have also been studies both pharmacologic and outcomes based on the utility of early administration of activated charcoal for ingestions of DOACs3."

Case report • Clinical • Cardiovascular • Congestive Heart Failure • Heart Failure • Hypotension • Peripheral Arterial Disease • ACSL3

Clotting and Bleeding - A Rare Case of Catastrophic Trousseau Syndrome (ATS 2025) - "Following pulmonary artery thrombectomy he was discharged on apixaban with plans for outpatient biopsy...Multiple VTE and PEs raise concern for occult malignancy. Choice of anticoagulation is complicated and based on multiple factors; confounders such as bleeding or thrombocytopenia make anticoagulation treatment particularly challenging."

Clinical • Cardiovascular • Cerebral Hemorrhage • CNS Disorders • Hematological Disorders • Hematological Malignancies • Ischemic stroke • Pain • Pancreatic Adenocarcinoma • Pancreatic Cancer • Pulmonary Disease • Pulmonary Embolism • Thrombocytopenia • Thrombosis

Refractory Recurrent Venous Thrombosis Resistant to Anticoagulation in a Patient With Hepatic Dysfunction (ATS 2025) - "He was initiated on prophylactic lovenox on admission and transitioned to fondaparinux on day three following ultrasound...Anticoagulation was switched to rivaroxaban; however, thrombosis burden progressed...He was ultimately discharged on long-term Apixaban therapy...The H63D mutation may have further influenced iron metabolism and endothelial function. This case emphasizes necessitation of tailored therapeutic strategies to manage hemostatic balance in patients with advanced liver disease and offers insights for clinicians facing similar patient presentations."

Clinical • Addiction (Opioid and Alcohol) • Anemia • Cardiovascular • Fibrosis • Heart Failure • Hematological Disorders • Hepatology • Immunology • Liver Failure • Pain • Thrombosis

A Challenging Case of Mycobacterium Chimaera Pulmonary Infection in an Elderly Patient With Recurrent Pneumonia (ATS 2025) - "Case presentation:An 80-year-old male with a history of diabetes, hypertension , atrial fibrillation on Eliquis, and OSA on CPAP experienced multiple hospitalizations due to persistent cough and progressively worsening shortness of breath...He was treated with IV piperacillin-tazobactam and doxycycline and discharged on these antibiotics...Treatment requires prolonged multidrug regimens including macrolides, rifamycin, and ethambutol. This case emphasizes the importance of considering M. chimaera in patients with persistent pulmonary infections that do not respond to standard antibiotics. Effective management requires a multidisciplinary approach to address the complexities and improve patient outcomes."

Clinical • Atrial Fibrillation • Cardiovascular • Chronic Cough • Cough • Diabetes • Fatigue • Hypertension • Infectious Disease • Metabolic Disorders • Nontuberculous Mycobacterial Disease • Pneumonia • Respiratory Diseases

Fungal Foe- A Case of Invasive Pulmonary and Cutaneous Aspergillosis in Immunocompromised Patient (ATS 2025) - "Case: A 67-year-old female with a history of extensive deep venous thrombosis of the right popliteal veins, atrial fibrillation post-cardioversion on apixaban, tachycardia-induced cardiomyopathy, COPD on home oxygen, rheumatoid arthritis on prednisone, and chronic kidney disease IIIB (baseline Cr 1.6), presented from a nursing facility for hypoxia and leukocytosis, unresponsive to outpatient therapy with azithromycin, doxycycline, and increased prednisone...She was admitted for acute-on-chronic hypoxic respiratory failure secondary to multifocal pneumonia and COPD exacerbation, was started on ceftriaxone, methylprednisolone, and nebulizations...Initially treated with amphotericin B due to potential interactions of azole antifungals with amiodarone, later transitioned to oral isavuconazonium (Cresemba)...Cutaneous aspergillosis in our patient is thought to be secondary to hematogenous spread from pulmonary infection, given the late onset of presentation. Voriconazole is..."

Clinical • Atrial Fibrillation • Cardiomyopathy • Cardiovascular • Chronic Kidney Disease • Chronic Obstructive Pulmonary Disease • Cough • Hematological Disorders • Immunology • Infectious Disease • Inflammatory Arthritis • Nephrology • Novel Coronavirus Disease • Otorhinolaryngology • Pneumonia • Pulmonary Disease • Renal Disease • Respiratory Diseases • Respiratory Syncytial Virus Infections • Rheumatoid Arthritis • Rheumatology • Sinusitis • Thrombosis