Apixaban Induced Hepatotoxicity in a Chronic Kidney Disease Patient with Left Ventricular Apical Clot

Pulak Azad¹, Yasir Rizvi², and Lakshmi Kant Jha²

¹DrNB Resident, Dharamshilla Narayana Superspeciality, India
²Senior Consultant and Director, Nephrology, Dharmashilla Narayana Superspeciality Hospital, India

*Corresponding Author: Pulak Azad, DrNB resident, Nephrology, Dharamshilla Narayana Superspeciality, Delhi, India.

DOI: 10.64258/3067-7130.2025.1020017

Submission Date: April 23, 2025

Published Date: May 7, 2025

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Abstract

Drug induced liver injury (DILI) is a common occurrence in clinical practice mostly seen with anti-tubercular drugs. Drug cessation is crucial part of management. But DILI secondary to direct oral anticoagulant (DOAC) is rare. Especially risk of hepatotoxicity with apixaban is lower than other DOACs. A 78 years old diabetic and hypertensive female with coronary artery disease admitted with acute on CKD stage-3 (serum creatinine 1.7) underwent echocardiography revealing left ventricular apical clot. Cardiology team added apixaban following which patient developed anorexia, nausea and abdominal discomfort. Liver function test revealed transaminitis with liver enzymes suggestive DILI. Patient was neither on any concomitant hepatotoxic drugs nor had a history of liver disease. Apixaban was discontinued and enoxaparin was started following which transaminitis improved and patient became better.

Keywords

Apixaban, Hepatotoxicity, Drug induced liver injury, Coronary artery disease

Citation

Pulak A, Yasir R, Lakshmi KH (2025) Apixaban Induced Hepatotoxicity in a Chronic Kidney Disease Patient with Left Ventricular Apical Clot. On J Clin & Med Case Rep 1(4): 1-2.