Reactions 1704, p46 - 2 Jun 2018
Gastrointestinal bleeding and hair loss: 2 case
A case series described a 78-year-old woman and a 58-year-
old woman, who developed gastrointestinal bleeding or hair
loss during treatment with apixaban [times to reactions onset
The 78-year-old woman, who had atrial fibrillation, started
receiving treatment with oral apixaban 5mg twice daily at an
MDRD (Modification of Diet in Renal Disease) of 36 mL/min.
Her medical history was significant for chronic renal
insufficiency, type 2 diabetes mellitus, hypertension and
microcytic anaemia because of blood loss from gastritis. Her
cardiologist had asked her general physician to adjust the dose
of apixaban to 2.5mg twice daily in case the clearance was in
the range of 15
30 mL/min and recommended control of liver
and renal function. After few months, she developed
microcytic anaemia associated to upper GI blood loss,
confirmed by a gastroscopy. Her eGFR deteriorated while anti-
Xa activity increased (with apixaban levels of 41
Treatment with apixaban was stopped for few days and was
resumed at the dose of 2.5mg twice daily. However, trough
anti-Xa levels showed elevated levels. She developed new
episodes of GI bleeding and apixaban was completely
discontinued [outcomes not stated].
The 58-year-old woman was diagnosed with breast
carcinoma in 2008 and cervix carcinoma in 2015. Her medical
history was significant for hair loss. As her cervix carcinoma
went in remission, she started receiving treatment with oral
apixaban 5mg twice daily but her hair loss recurred. Therefore,
apixaban was switched to dabigatran. Treatment with
dabigatran was continued with no complaints of hair loss.
Author comment: "With the cervix carcinoma in
remission, she was started on a DOAC, apixaban 5 mg bd;
unfortunately, hair loss recurred10 and we switched to
another class of DOAC, dabigatran. . .". "As she experienced
new episodes of gastrointestinal bleeding, anticoagulation had
to be stopped completely, eventually."
Ten Cate H, et al. Direct oral anticoagulants: When to consider laboratory testing?.
[Review]. International Journal of Laboratory Haematology 40 (Suppl. 1): 30-33,
May 2018. Available from: URL: http://doi.org/10.1111/ijlh.12816 -
Reactions 2 Jun 2018 No. 17040114-9954/18/1704-0001/$14.95 Adis © 2018 Springer International Publishing AG. All rights reserved