Rectus sheath hematoma associated with apixaban

  • Kulothungan Gunasekaran | Division of Hospital Medicine, Henry Ford Hospital, Detroit, MI, United States.
  • Amanda R. McFee Winans Department of Pharmaceutical Care Services, Section of Clinical Pharmacy, Bassett Medical Center, Cooperstown, NY, United States.
  • Swetha Murthi Department of Internal Medicine, Sinai Grace Hospital, Detroit, MI, United States.
  • Mudassar Raees Ahmad Division of Hospital Medicine, Geisinger Hospital, Danville, PA, United States.
  • Scott Kaatz Division of Hospital Medicine, Henry Ford Hospital, Detroit, MI, United States.


Apixaban is an oral anticoagulant that directly inhibits Factor Xa and is indicated for the prophylaxis and treatment of deep venous thrombosis and stroke prevention in non-valvular atrial fibrillation. Rectus sheath hematoma is a rare, life-threatening complication of anticoagulant treatment. We describe a case of an elderly patient on apixaban for the treatment of deep venous thrombosis who developed severe abdominal pain during hospitalization. Computed tomography of the abdomen revealed left rectus sheath hematoma. Apixaban was discontinued and the patient was monitored for extension of the hematoma. After 2 days she was discharged home. Outpatient computed tomography 1 month later showed complete resolution of the rectus sheath hematoma. We recommend that clinicians become aware of the potential for rare and serious bleeding complications of anticoagulants and identify the need for early recognition and prompt management.


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Case Reports
Rectus sheath hematoma, apixaban, anticoagulation.
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How to Cite
Gunasekaran, K., McFee Winans, A. R., Murthi, S., Ahmad, M., & Kaatz, S. (2017). Rectus sheath hematoma associated with apixaban. Clinics and Practice, 7(3).

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