Year: 2026
Type: article
Study design: Case Report
Abstract: Direct oral anticoagulants are used for stroke prevention in selected patients with atrial fibrillation who receive hemodialysis. Randomized trial data remain limited in this population, and the anticoagulant effect of a given dose may vary considerably between patients. We report a 56-year-old man receiving hemodialysis three times weekly who was taking apixaban 5 mg twice daily and developed persistent hypotension and abdominal pain during dialysis. The early findings suggested dialysis-associated hypotension or sepsis. Emergency department point-of-care cardiac ultrasound showed a large circumferential pericardial effusion, leading to urgent cardiology evaluation for obstructive shock. Computed tomography obtained during the same evaluation described the effusion as large and possibly hemorrhagic. Pericardiocentesis was unsuccessful because most of the fluid was posterior. Shortly after transfer to the intensive care unit, the patient developed pulseless electrical activity arrest and underwent an emergent subxiphoid pericardial window. Approximately 450 mL of bloody fluid was drained, followed by hemodynamic improvement. Cytology showed no malignant cells, and fluid cultures were negative. This case also highlights the uncertainty surrounding the use of full-dose apixaban in patients receiving hemodialysis, particularly after a major bleeding event.
Source: Cureus
Institution: Trinity Health
Language: English
Subfield: Cardiology and Cardiovascular Medicine
Field: Medicine
Domain: Health Sciences
Open Access status: diamond
OpenAlex ID: W7225649360