Table 1 Summary of published case reports on direct-acting oral anticoagulant-associated rectus sheath hematoma
Reference | Year | Country | Gender | Age | Symptoms | Underlying diseases | Type of DOAC | Clinical course |
|---|---|---|---|---|---|---|---|---|
Kocayigit et al. [9] | 2014 | Turkey | F | 75 | Abdominal pain, dyspnoea and leg swelling | DM, HT, AF, MR, TR, pulmonary hypertension, Alzheimer’s disease | Rivaroxaban 10 mg daily | CT showed 5.5 cm RSH Hb 5.5 g/dL on admission INR 1.48; PT/aPTT/anti-FXa not reported Managed conservatively with FFP and PC transfusion Developed respiratory failure and died on 15th days due to renal dysfunction and sepsis |
Aktas et al. [10] | 2016 | Turkey | F | 71 | Abdominal pain and dyspnoea for 24 h Cough for 1 week due to URI | AF, CAD | Apixaban 5 mg bd | USG showed 11 × 7.5x3cm left RSH Hb 11.5 mg/dL and eGFR 33 ml/min/1.73m2 on admission Clotting profiles/anti-FXa not reported Managed conservatively and discharged 1 week later with apixaban 2.5 mg bd |
Talari et al. [11] | 2016 | US | M | 65 | Right sided abdominal pain for 1 week; cough for several weeks after starting losartan | Metabolic syndrome, DVT of lower limbs and PE | Rivaroxaban (dose not specified) | CT showed 14.5 × 9x4.5 cm right RSH Hb dropped from 13.3 to 9.5 g/dL PT/INR were ‘normal’; aPTT/anti-FXa not reported Conservatively managed with pain control and PC transfusion No mention if anticoagulation was resumed |
Gunasekaran et al. [12] | 2017 | US | F | 68 | Acute onset of severe abdominal pain in mid-epigastric radiating to back | DM, HT, hyperlipidemia, OSA, OA of knees, depression, left total knee replacement 1 month before admission, left leg DVT | Apixaban 10 mg bd | CT showed 10 × 4x17 cm left RSH Hb dropped from 9.7 to 7 g/dL ‘Normal’ PT/INR; aPTT/anti-FXa not reported Conservatively managed with PC transfusion IVC filter was inserted CT 1 month later showed resolution of RSH and aspirin 81 mg daily was added afterwards |
Elango et al. [13] | 2018 | UK | F | 69 | Acute severe lower abdominal pain after severe coughing | AF | Apixaban (dose not specified) | CT showed 7.5 cm left RSH Hb dropped from 15.2 to 12.9 g/dL Clotting profiles/anti-FXa not reported Conservatively managed and apixaban withheld for 1 week Plan for resumption of apixaban by primary care physician |
Borekci [5] | 2019 | Turkey | F | 76 | Acute abdominal pain after cough | DM, HT, AF, asthma, Hyperlipidemia, Hypothyroidism | Rivaroxaban 15 mg daily | CT showed 10 × 4x12cm left Hb 9.5 g/dL ‘Normal’ INR; PT/aPTT/anti-FXa not reported RSH with bleeding in retroperitoneum Conservatively managed with PC transfusion Discharged 7 days later with dabigatran 110 mg bd |