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Case Reports
. 2024 Oct 21;12(10):263.
doi: 10.3390/diseases12100263.

Apixaban-Induced Esophagitis Dissecans Superficialis-Case Report and Literature Review

Alexandru Ionut Coseru  1 , Irina Ciortescu  1   2 , Roxana Nemteanu  1   2 , Oana-Bogdana Barboi  1   2 , Diana-Elena Floria  1   2 , Radu-Alexandru Vulpoi  1   2 , Diana Georgiana Strungariu  1 , Sorina Iuliana Ilie  1 , Vadim Rosca  1   2 , Vasile-Liviu Drug  1   2 , Alina Plesa  1   2
Affiliations
Case Reports

Apixaban-Induced Esophagitis Dissecans Superficialis-Case Report and Literature Review

Alexandru Ionut Coseru et al. Diseases. .

Abstract

Novel direct oral anticoagulants (DOACs) are prescribed worldwide in the treatment of non-valvular atrial fibrillation. Adverse reactions have been reported following the use of DOACs. One notable trend in the literature is the growing number of reported cases of esophagitis dissecans superficialis (EDS) generated by DOAC use. We hereby report the case of a 73-year-old woman who presented to the hospital with asthenia, dysphagia, and melena two days prior to admission. The patient had taken apixaban due to non-valvular paroxysmal atrial fibrillation for a few weeks. The biological panel showed moderate anemia with a hemoglobin level of 7.7 g/dL Apixaban-induced EDS was diagnosed by the characteristic endoscopic findings. The patient received treatment with a proton pump inhibitor (pantoprazole) in a double dose. Also, an iron treatment was recommended for a period of six months. The follow-up endoscopy at one month confirmed the healing of the esophageal lesions. The case was discussed with the cardiologist. The first anticoagulant treatment proposed after discharge was a vitamin K antagonist (acenocumarol) but the patient refused this medication and thus it was decided to initiate rivaroxaban. Although DOACs have demonstrated their efficacy in the prevention and treatment of stroke and thromboembolism among the aging demographic, cases of DOAC-induced EDS will continue to pose numerous challenges for physicians worldwide.

Keywords: apixaban; esophagitis dissecans superficialis; upper gastrointestinal bleeding.

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Conflict of interest statement

The authors declare no conflicts of interest.

Figures

Figure 1
Figure 1
Endoscopic findings showing the esophageal mucosa with longitudinal strips from the sloughing of the mucosa with a “gift-wrap ribbons” or “crepe-paper” appearance.
Figure 2
Figure 2
Improved endoscopic appearance of the esophageal mucosa one month after treatment.
Figure 3
Figure 3
Proposed diagnostic and therapeutic algorithm in patients with esophagitis dissecans superficialis.
See this image and copyright information in PMC

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