apixaban / Generic mfg. - LARVOL DELTA

Difficult airway in a patient with multiple co-morbidities for a difficult neurosurgical procedure (ASA 2025) - "A 71-year-old with metastatic tonsillar squamous cell carcinoma (status-post radiation and prior tracheostomy), chronic obstructive pulmonary disease (home oxygen), and atrial fibrillation (apixaban), presented with an unstable C2/odontoid fracture due to metastatic disease...The patient underwent a unique awake fiberoptic technique prior to safe and successful surgery. This case highlights the importance of thorough assessment of candidacy for awake fiberoptic intubation, as well as multidisciplinary approach and expert involvement in planning of complex airway management."

Clinical • Atrial Fibrillation • Cardiovascular • Chronic Obstructive Pulmonary Disease • Immunology • Musculoskeletal Diseases • Pulmonary Disease • Respiratory Diseases • Squamous Cell Carcinoma

Saddle Pulmonary Embolism with Right Heart Strain in Patient Presenting for Spinal Decompression for Cauda Equina Syndrome (ASA 2025) - "His neurologic symptoms then resolved. He was discharged on Apixaban."

Clinical • Back Pain • Cardiovascular • Hypotension • Musculoskeletal Pain • Pulmonary Embolism • Respiratory Diseases

Cardiac Goal Directed Management and Intraoperative Optimization in a patient with Significant CAD for a Free Flap (ASA 2025) - "We present a 69-year-old male with squamous cell carcinoma of the mandible, CAD (subtotal RCA occlusion, 50% mLAD), a 5cm ascending aortic aneurysm, previous CVA, DVT/PE on Eliquis, COPD, and HTN undergoing free flap reconstruction...Intraoperative management, guided by Edwards HPI, titrated inotropes and vasoactive agents to maintain coronary and flap perfusion during a lengthy procedure with significant anesthetic effects. Despite significant hemodynamic challenges, the patient was extubated uneventfully, and the free flap remained viable postoperatively."

Clinical • Anesthesia • Cardiovascular • Chronic Obstructive Pulmonary Disease • Immunology • Respiratory Diseases • Squamous Cell Carcinoma

Anesthetic Challenges in a Patient with Myotonic Dystrophy Undergoing Pancreaticoduodenectomy (Whipple Procedure) (ASA 2025) - "We present an 83-year-old male with a complex history of myotonic dystrophy (DM), paroxysmal atrial fibrillation on apixaban, MVP, GERD, PVCs, AV block s/p pacemaker, OSA, BPH, and insomnia. Here we highlight critical perioperative considerations in a DM patient for a major abdominal surgery, which has not been previously described. Notable considerations include using the TIVA with propofol and remifentanil, use of cisatracurium over succinylcholine, truncal regional block, and sugammadex reversal."

Clinical • Anesthesia • Atrial Fibrillation • Biliary Cancer • Cardiovascular • Cholangiocarcinoma • CNS Disorders • Gastroesophageal Reflux Disease • Genetic Disorders • Insomnia • Muscular Dystrophy • Myotonic Dystrophy • Pancreatic Cancer • Sleep Disorder • Solid Tumor

Balancing Bleeding Risk and Embolic Threat: A Multidisciplinary Approach to Urgent Hip Fracture Surgery (ASA 2025) - "A 90-year-old female with heart failure with reduced ejection fraction (HFrEF) and left ventricular thrombus on apixaban presented with a left hip fracture requiring urgent surgery...A positive common femoral vein DVT scan led to IVC filter placement prior to surgery. Preoperative risk stratification by the anesthesiologist and multidisciplinary collaboration were pivotal in managing anticoagulation, minimizing right heart failure risk, and ensuring safe fracture fixation in this high-risk geriatric patient."

Surgery • Anesthesia • Cardiovascular • Congestive Heart Failure • Geriatric Disorders • Heart Failure • Musculoskeletal Diseases • Orthopedics • Thrombosis

Navigating Pericardial Tamponade in a Patient with Multiple Comorbidities (ASA 2025) - "Notably, she had eaten a full meal five hours prior and had taken apixaban and empagliflozin that morning. Bedside echocardiogram confirmed a large pericardial effusion, right atrial collapse, and interventricular septal flattening. Anesthetic management was challenging and required careful consideration of anticoagulation reversal, aspiration prevention, hemodynamic stability, and adequate analgesia during this emergent procedure."

Clinical • Anesthesia • Breast Cancer • Congestive Heart Failure • Heart Failure • Pulmonary Embolism • Solid Tumor • Thrombosis

The Ticking Time Bomb: Hypercoagulability in the Thoracic Perioperative Window (ASA 2025) - "Further workup discovered BLE DVTs, for which patient was placed on Apixaban...Patient was intubated & bedside TTE highly concerning for PE, for which he was transported to IR for emergent thrombectomy. The patient arrested and was placed on peripheral VA ECMO."

Cough • Infectious Disease • Respiratory Diseases

Management for Urgent Femur Fixation in a Post-Lung Transplant Patient on Apixaban with CKD and Distorted Neuraxial Anatomy (ASA 2025) - "As surgical timing approached the 72-hour threshold for increased hip fracture mortality, four-factor PCC (Kcentra) was administered. General anesthesia was administered, and the procedure continued uneventfully. The patient was discharged without complications."

Clinical • Anesthesia • Atrial Fibrillation • Cardiovascular • Chronic Kidney Disease • Infectious Disease • Musculoskeletal Diseases • Nephrology • Orthopedics • Pneumonia • Renal Disease • Respiratory Diseases • Transplantation

Orthotopic Heart Transplant in a Patient with NICM and HIT requiring PLEX and Alprostadil (ASA 2025) - "Intraoperatively, she was heparinized for cardiopulmonary bypass and received alprostadil with resumption of bivalirudin post-transplant. Her course was complicated by ARF requiring CRRT. She ultimately had renal recovery and was transitioned to Eliquis prior to discharging home."

Clinical • Cardiovascular • Congestive Heart Failure • Heart Failure • Transplantation

Aortic Valve Replacement for Infective Endocarditis Complicated by Heparin-Induced Thrombocytopenia and Intraoperative Pulmonary Shunting (ASA 2025) - "62-year-old man with aortic valve endocarditis presented with embolic limb ischemia requiring thromboembolectomy and fasciotomy.Transthoracic echocardiography revealed severe aortic insufficiency with a mobile valve vegetation, prompting surgical aortic valve replacement.He was initially anticoagulated with heparin, but developed heparin-induced thrombocytopenia with a persistently positive HIT antibody.He was treated for deep vein thrombosis with apixaban, which was bridged for surgery with argatroban infusion.The case proceeded with an intraoperative Flolan protocol to prevent HIT-associated thrombosis during heparin administration for cardiopulmonary bypass. The procedure was complicated by hypoxemia attributed to Flolan-associated pulmonary shunting.This case highlights the perioperative challenges in the setting of HIT and Flolan-associated hemodynamic instability."

Cardiovascular • Hematological Disorders • Thrombocytopenia • Thrombosis

Intraoperative Hemodynamic Collapse in Spine Surgery: A Case of Pulmonary Embolism Mimicking Hemorrhagic Shock (ASA 2025) - "The patient was hemodynamically stable, treated with heparin, transitioned to apixaban, and discharged. This case highlights the diagnostic challenge of intraoperative PE in spine surgery with hemodynamic instability."

Clinical • Surgery • Asthma • Cardiovascular • CNS Disorders • Gastroesophageal Reflux Disease • Hematological Disorders • Hypertension • Hypotension • Immunology • Multiple Sclerosis • Orthopedics • Pulmonary Embolism • Respiratory Diseases

The Cuff Did It: A Benign Rash Mimic in a Diabetic Vascular Patient (ASA 2025) - "She was maintained on aspirin, with apixaban and clopidogrel appropriately held preoperatively. The cuff and IV were removed, the patient remained hemodynamically stable, and surgery proceeded without complication. This case highlights the importance of recognizing this rare but harmless dermatologic finding to avoid unnecessary alarm or intervention during anesthetic care."

Clinical • Anesthesia • Cardiovascular • Diabetes • Metabolic Disorders • Peripheral Arterial Disease • Type 1 Diabetes Mellitus

Breaking Age Barrier: Neuraxial Anesthesia for an Intramedullary Rod Insertion of Right Femur in a 99-year old patient (ASA 2025) - "A 99-year-old female (BMI 18.8) with significant comorbidities including atrial fibrillation on apixaban, sick sinus syndrome with pacemaker, CHF, CAD, tricuspid regurgitation, pulmonary hypertension, and CKD stage III presented for intramedullary rod fixation following a mechanical fall...An L2-L3 spinal was placed under fluoroscopic guidance with the patient in the prone position, then repositioned supine for surgery. This case highlights the importance of individualized anesthetic planning to safely manage frail, high-risk elderly patients undergoing urgent orthopedic procedures."

Clinical • Anesthesia • Atrial Fibrillation • Cardiovascular • Chronic Kidney Disease • Orthopedics • Pulmonary Arterial Hypertension • Pulmonary Disease • Respiratory Diseases

DRUG-INDUCED PULMONARY HEMORRHAGE DUE TO BICALUTAMIDE, APIXABAN, AND CLOPIDOGREL (CHEST 2025) - No abstract available

Hematological Disorders

HEMORRHAGIC CARDIAC TAMPONADE IN AN END-STAGE RENAL DISEASE PATIENT ON APIXABAN (CHEST 2025) - No abstract available

Clinical • Hematological Disorders • Nephrology • Renal Disease

TRENDS IN DIRECT ORAL ANTICOAGULANT USE AND EXPENDITURES: A COMPARATIVE ANALYSIS OF RIVAROXABAN AND APIXABAN FROM 2014 TO 2022 (CHEST 2025) - No abstract available

Cardiovascular • Heart Failure

BLEEDING LUNGS: AN UNSEEN RISK OF APIXABAN (CHEST 2025) - No abstract available

Pulmonary Disease • Respiratory Diseases

Postoperative Stroke Through a Patent Foramen Ovale in a Patient With Lung Cancer: A Case Report. (PubMed, Cureus) - "Treatment was initiated with aspirin on postoperative day 2, switched to apixaban after PFO confirmation. Perioperative strokes are often observed in patients with multiple underlying risk factors. In pulmonary resection, pulmonary vein stump thrombosis has been proposed as a causative mechanism, although PBE through PFO warrants consideration as an important alternative etiology because lung resection creates ideal conditions for PBE by combining increased venous thrombosis risk with elevated right heart pressures due to loss of the pulmonary vascular bed."

Journal • Atrial Fibrillation • Cardiovascular • CNS Disorders • Diabetes • Hematological Disorders • Hypertension • Lung Cancer • Metabolic Disorders • Oncology • Solid Tumor • Thrombosis

Comparative Effectiveness of Direct Oral Anticoagulants and Warfarin on Venous Thromboembolism in Cancer Patients. (PubMed, Cancer Med) - "This study provides insight into the effectiveness of DOACs compared to warfarin for VTE in cancer patients. Patients on DOACs had lower risks of VTE recurrence and major bleeding. We suggest healthcare professionals consider the potential benefits of individual DOACs when making treatment decisions."

Clinical • HEOR • Journal • Retrospective data • Cardiovascular • Oncology • Venous Thromboembolism

When Liver Cancer Strikes the Kidney: A Case of Uncommon Metastasis (ACG 2025) - "The patient was started on apixaban for therapeutic anticoagulation...Systemic immune checkpoint inhibitors (tremelimumab + durvalumab) were initiated...In our case, immune checkpoint inhibitors were used instead of sorafenib due to superior survival benefits. Evidence from additional reports are needed to guide optimal treatment for renal metastasis from HCC.Figure: Histopathological findings of HCC and Kidney Mass"

Clinical • IO biomarker • Fibrosis • Gastroenterology • Hepatitis C • Hepatocellular Cancer • Hepatology • Immunology • Infectious Disease • Liver Cancer • Liver Cirrhosis • Oncology • Pulmonary Disease • Respiratory Diseases • Solid Tumor • Squamous Cell Carcinoma • Thrombosis

In vivo Pharmacokinetic Interactions Between Palbociclib and Rivaroxaban or Apixaban: Implications for Increased Drug Exposure and Dose Adjustments. (PubMed, Drug Des Devel Ther) - "The remarkable increased exposure of DOAC suggest that palbociclib likely enhance intestinal absorption mediated by decreased P-gp and BCRP expression, indicating markedly improved bioavailability for both drugs. These pharmacokinetic interactions provide valuable insights for optimizing dosing regimens of palbociclib in combination with apixaban or rivaroxaban, potentially reducing toxicity risks and enhancing the safety of co-administration in clinical settings."

Journal • PK/PD data • Preclinical • Cardiovascular • Oncology • Venous Thromboembolism • CYP3A4

Secondary Colonic Plasmacytoma Presenting as a Rare Cause of Intussusception (ACG 2025) - "We describe a case of secondary colonic EMP presenting clinically with hematochezia and intussusception.Case Description/ A 59-year-old male with a new diagnosis of MM, recently initiated on induction chemotherapy and apixaban, presented with a single episode of gelatinous hematochezia...The patient subsequently received one fraction of radiation to the mass, followed by alternative induction chemotherapy regimen including Daratumumab, Lenalidomide, Bortezomib, and Dexamethasone. Secondary colonic EMP is a rare manifestation and sequela of MM, often indicating aggressive disease and a poor prognosis...CT of the Abdomen Demonstrating Ileocolonic IntussusceptionFigure: Figure 2. Colonoscopy Demonstrating an Obstructing Mass in the Ascending Colon"

Gastrointestinal Disorder • Hematological Malignancies • Multiple Myeloma • Pediatrics • Plasmacytoma • NCAM1 • PAX5 • SDC1 • SYP

Pfizer Reports Strong Second-Quarter 2025 Results And Raises 2025 EPS Guidance (Businesswire) - "Second-quarter 2025 revenues totaled $14.7 billion, an increase of $1.4 billion, or 10%, compared to the prior-year quarter, reflecting an operational increase of $1.3 billion, or 10%, as well as a favorable impact of foreign exchange of $22 million. The operational increase was primarily driven by an increase in revenues for the Vyndaqel family, Comirnaty, Paxlovid, Padcev, Eliquis and several other products across categories despite the unfavorable impact of higher manufacturer discounts resulting from the Inflation Reduction Act (IRA) Medicare Part D Redesign."

Commercial • Cardiovascular • CNS Disorders • Novel Coronavirus Disease • Urothelial Cancer

Beyond the Adenoma: A Rare Case of Colonic Melanoma Metastasis (ACG 2025) - "We report a case of metastatic melanoma found incidentally within colonic polyps during evaluation for symptomatic anemia.Case Description/ A 76-year-old male with metastatic melanoma (lungs, brain, left ear) was receiving Opdualag and Mektovi. His history included non-small cell lung cancer, atrial fibrillation on apixaban, CAD, and stage III CKD...First line systemic therapy includes anti–PD–1 agents (e.g. nivolumab, pembrolizumab), alone or with anti–CTLA–4. BRAF V600E/K-mutated tumors may respond to BRAF/MEK inhibitors. In conclusion, awareness of this rare entity is key to accurate diagnosis and timely oncologic management.Figure: High-power (40X) H&E-stained section of ascending colon shows malignant melanoma cells with abundant melanin pigment (circled) and prominent "cherry-red" nucleoli (arrows).Figure: Melan-A immunohistochemical stain of the ascending colon, highlighting malignant melanoma cells in brown."

Clinical • IO biomarker • Anemia • Atrial Fibrillation • Chronic Kidney Disease • Colon Cancer • Colonic Polyps • Colorectal Cancer • Fatigue • Gastroenterology • Gastrointestinal Disorder • Lung Cancer • Melanoma • Non Small Cell Lung Cancer • Pulmonary Disease • Solid Tumor • MLANA • SOX10

An Uncharted Path of Metastasis: A Case Report of Sigmoid Colon Cancer with Synchronous Vaginal and Urethral Spread. (PubMed, Diseases) - " A 59-year-old woman with a history of deep vein thrombosis treated with apixaban presented with chronic constipation and pelvic bleeding...Treatment included chemotherapy (capecitabine and oxaliplatin), panitumumab, and pelvic radiotherapy...Early diagnosis, based on imaging and histology, alongside molecular characterization, is crucial for effective personalized therapy. Multidisciplinary coordination is key to optimizing clinical outcomes in these rare metastatic presentations."

Journal • Cardiovascular • Colon Adenocarcinoma • Colon Cancer • Colorectal Adenocarcinoma • Colorectal Cancer • Constipation • Gastroenterology • Gastrointestinal Disorder • Gynecologic Cancers • Hematological Disorders • Oncology • Pain • Palliative care • Sarcoma • Solid Tumor • Thrombocytopenia • Thrombosis • BRAF