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. 2025 Mar 9;17(3):e80299.
doi: 10.7759/cureus.80299. eCollection 2025 Mar.

Bleeding Complications Following Paracentesis in Patients Taking Apixaban

Sarah Van Dorin  1 , Andrei Schwartz  1 , Rosarie Tudas  2 , Kevin Sanchez  1 , Mohammed Amarneh  2 , Ethan Kuperman  1
Affiliations

Bleeding Complications Following Paracentesis in Patients Taking Apixaban

Sarah Van Dorin et al. Cureus. .

Abstract

Background Both ascites and thrombosis are common complications of liver disease. Abdominal paracentesis to drain ascites has a low reported risk of hemorrhage, but it is unknown how exposure to direct oral anticoagulants (DOACs) such as apixaban increases this risk. Objectives We aim to quantify the rate of major bleeding and identify additional risk factors for bleeding in patients on apixaban undergoing paracentesis. Methods We performed a retrospective cohort study for all patients exposed to apixaban within seven days prior to paracentesis at a single US academic hospital between January 1, 2016, and April 1, 2022. Abstracted data included the presence or absence of hemorrhagic complications, dosing and timing of apixaban administration, and patient comorbidities. Results We identified 365 paracenteses in 91 unique patients. There were 20 (5.5%) reported hemorrhages, nine (2.5%) of which were plausibly related to the procedure. Four (1.1%) patients suffered fatal hemorrhage. Patients taking 10 mg twice daily of apixaban (3/8, 38%), co-prescription of apixaban with more than one additional antiplatelet or anticoagulant (3/16, 19%), apixaban taken within six hours of the procedure (6/37, 16%), and inpatient status (8/158, 5.1%) were associated with bleeding. While internal medicine residents (3/38, 7.9%) had a higher rate of hemorrhage than interventional radiologists (6/289, 2.1%), this difference was negligible when restricted to inpatients (3/38 versus 5/100). Conclusions The rate of bleeding after paracentesis for patients taking apixaban was much higher than historical estimates. Apixaban exposure, especially on high doses, within six hours of the procedure or on additional anticoagulant medications, significantly increases the rate of hemorrhagic complications of paracentesis.

Keywords: abdominal paracentesis; apixaban; cirrhosis; perioperative medication management; periprocedural bleeding; therapeutic anticoagulation.

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Conflict of interest statement

Human subjects: Consent for treatment and open access publication was obtained or waived by all participants in this study. The University of Iowa Institutional Review Board issued approval 202204336. Animal subjects: All authors have confirmed that this study did not involve animal subjects or tissue. Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: REDCap access for this paper was supported by the National Center For Advancing Translational Sciences of the National Institutes of Health under Award Number UM1TR004403. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health. No other funding was used for this project. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work.

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