Angioedema: a previously unreported adverse effect of Apixaban (Eliquis)

Angioedema: a previously unreported adverse effect of Apixaban (Eliquis)

92-year-old male with past medical history for paroxysmal atrial fibrillation and sick sinus syndrome s/p dual chamber pacemaker was maintained in sinus rhythm with sotalol. Prior attempts at anticoagulation with warfarin lead to spontaneous hematoma in the upper extremity leading to discontinuation of the drug. He was started on apixaban renally dosed at 2.5 mg oral twice daily. However, the next morning he subsequently developed periorbital facial edema, circumoral pruritis, symmetric swelling of his oral mucosa and tongue. Suspecting a hypersensitivity reaction, apixaban was discontinued. The following morning all signs of swelling and pruritis had resolved without the use of corticosteroids. This case demonstrates the unusual occurrence of angioedema with apixaban.