Spontaneous Spleen Rupture and Apixaban

Novel oral anticoagulants (NOACs) are now widely used. Spontaneous splenic rupture (SLR) is a rare condition. It is life-threatening, especially if not immediately recognized. Previous studies have shown an association between NOAC use and SLR. We report a case of a 53-year-old female patient who responded to cardiopulmonary resuscitation (CPR) after SLR. The patient, who had an external cardiac device for heart failure 13 months ago was admitted to our emergency department. She was unconscious, pale, hypotensive and had tachycardia. Free fluid was detected in the peritoneum by bedside ultrasonography. The patient was resuscitated for 20 minutes after arrest during the follow-up period. She was stabilized and computed tomography showed a large subcapsular splenic hematoma with active extravasation around the spleen, but persistent low urine output developed with hypotension despite resuscitation. She was taken to the operating room for splenectomy and abdominal washing. She was then recovered and discharged 17 days later. We wanted to draw attention to a patient with SLR due to NOACs. Rapid diagnosis and aggressive early resuscitation are critical in the management of NOAC associated SLR.