Emergency Cases Northwest Group

067 Not Thin Enough

Situation

Man on apixaban suffered a PE.

Background

A 22 year old man presented with central chest pain, sharp but not pleuritic, sometimes related to meals. He had DVT x2 in the past and was lupus anticoagulant positive. On apixaban. Observations and ECG were normal.

Assessment

CTPA showed bilateral PEs. He was changed to warfarin.

Recommendation

He was compliant with his apixaban, so this was treatment failure.

DOACs can fail to prevent clots in some cases, such as: non compliance, cancer and pro-thrombotic conditions like this.

Lupus anticoagulant does not necessarily mean the patient has lupus, nor is it an anticoagulant; in fact in increases the risk of clots.



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Emergency Cases Northwest Group