Bilateral adrenal hemorrhage under apixaban in primary antiphospholipid syndrome

• Published in: La revue de medecine interne 2020-07, Vol.41 (7), p.489
• Main Authors: Lavoipierre, V, Talbot, M, Soubrier, C, De Sainte Marie, B, Seux, V, Solas, C, Morange, P, Bernit, E, Ebbo, M, Faucher, B, Harlé, J R, Schleinitz, N
• Format: Article
• Language: eng ; fre
• Subjects: Adrenal Gland Diseases - chemically induced; Adrenal Gland Diseases - diagnosis; Adrenal Glands - drug effects; Adrenal Glands - pathology; Antiphospholipid Syndrome - complications; Antiphospholipid Syndrome - diagnosis; Hemorrhage - chemically induced; Hemorrhage - diagnosis; Humans; Male; Middle Aged; Necrosis - chemically induced; Necrosis - diagnosis; Pyrazoles - adverse effects; Pyrazoles - therapeutic use; Pyridones - adverse effects; Pyridones - therapeutic use; Venous Thromboembolism - complications; Venous Thromboembolism - drug therapy
• ISSN: 1768-3122
• DOI: 10.1016/j.revmed.2019.09.003

Adrenal hemorrhage is a classical but rare complication of antiphospholipid syndrome, revealing diagnosis in one third of the cases. Anti-vitamin K therapy is the standard treatment but direct oral anticoagulants are discussed as an alternative. In the latest recommendations, it is advised not to use direct oral anticoagulants in the setting of antiphospholipid syndrome. We present a case of bilateral adrenal hemorrhage revealing primary antiphospholipid syndrome with triple positive antibody profile, in a 47-year-old man treated by apixaban for previous venous thromboembolism. To our knowledge, it is the first case of adrenal hemorrhage occurring during apixaban treatment in a patient with antiphospholipid syndrome. This case illustrates the inefficacy of direct oral anticoagulants to prevent thrombotic events in antiphospholipid syndrome, in accordance with the latest recommendations.