Apixaban-induced cutaneous hypersensitivity a case series with evidence of cross-reactivity

摘要

Atrial fibrillation is the most common cardiacarrhythmia affecting more than 2.7 million patientsin the US [1]. As the population ages, it is predictedto affect more than 6-12 million people by 2050 [1].Patients with atrial fibrillation are at increased risk forthromboembolic events and require anticoagulationtherapy to prevent thrombus formation and stroke.Apixaban, a novel oral anticoagulant that reversiblyand directly inhibits factor Xa, was approved by theFood and Drug Administration in 2012 and has beenwidely used in the U.S. since [2]. Apixaban isindicated to reduce the risk of stroke and systemicembolism in patients with non-valvular atrialfibrillation. According to the product monogram,hypersensitivity reactions (including drughypersensitivity, such as skin rash and anaphylacticreactions, such as allergic edema) and syncope werereported in the Aristotle study to occur in less than1% of patients on apixaban [2]. Very few cases ofcutaneous reactions related to apixaban have beenreported [5-8]. We describe four cases of apixabaninduced hypersensitivity reaction and a potentialcross-reactivity between apixaban and rivaroxaban.