Apixaban-Associated Spontaneous Splenic Rupture-A Case Report.

Introduction A 62-year-old lady presented to The Emergency Department (ED) with one-day history of dizziness, vomiting and feeling weak. ECG showed new onset Atrial Fibrillation. Four days ago, she was referred to the Cardiology team where she underwent PCI and was discharged on Apixaban and Plavix. Two days later she represented to the ED pale and hypotensive with BP 70/50. CT-Abdomen showed a large splenic hematoma and thickening of the inferior wall of the stomach. Treatment She was then taken for an emergency laparotomy with splenectomy and partial gastrectomy. She became septic post-operative, responded well to antibiotics and was discharged after 18 days on lifelong prophylactic oral antibiotics. Conclusion Spontaneous splenic rupture in a patient on Direct Oral Anticoagulants (DOAC) presented with abdominal pain could be even with no history of trauma.