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Said Abdirahman Ahmed,1 Mohamed Omar Hassan,1 Ishak Ahmed Abdi,1 Mohamed Abdullahi Mohamud,1 Mohamud Mire Waberi,1 Ahmed Elmi Abdi,1 Abdullahi Mohamed Hassan Fujeyra,2 Abdijalil Abdullahi Ali,3 Mohamed Sheikh Hassan4 1Department of Cardiology at Mogadishu Somali-Turkish Training and Research Hospital, Mogadishu, Somalia; 2Dean College of Medicine and Health Science at Abrar University, Mogadishu, Somalia; 3Cardiovascular Surgery Department at Mogadishu Somali-Turkish Training and Research Hospital, Mogadishu, Somalia; 4 4 Neurology Department at Mogadishu Somali-Turkish Training and Research Hospital, Mogadishu, SomaliaCorrespondence: Said Abdirahman Ahmed, Email Saciidcabdi114@gmail.comAbstract: New oral anticoagulants (NOACs) have become more popular in the last few decades. Although apixaban has been proven to be safer than warfarin and causes less hemorrhage in comparison to other NOACs, it still poses a risk of spontaneous bleeding. We present here an 81-year-old male known case of heart failure with reduced ejection fraction (HFrEF) associated with an apical thrombus of 0.93× 1.29 cm who presents with cognitive decline, slurred speech, and right side weakness following apixaban use for his apical thrombus. On further evaluation of non-contrast brain computerized tomography (CT), there was a large extra-axial subacute subdural hematoma with thick septations in the left parietal region, measuring 2.6 cm in thickness, causing an a mass effect, and an a midline shift of 1 mm. Following neurosurgery, cardiology, and anesthesiology discussions, the surgery was deferred due to his age and coexisting conditions with regular follow-ups. The patient has now gained full consciousness and is currently undergoing physiotherapy. This case highlights an elderly patient with apixaban-induced subdural hemorrhage, which is a rare entity in the medical literature. Although apixaban is safer than other NOACs, it may cause subdural hemorrhage.Keywords: new oral anticoagulants, NOACs, subdural hematoma, apical thrombus, heart ... |
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