Impending rupture of abdominal aortic aneurysm due to apixaban use

Abstract Direct oral anticoagulants (DOAC) are useful for preventing embolism and venous thrombosis in patients with atrial fibrillation. There are also reports that DOAC can dissolve existing intracardiac thrombus. Here, we report a case in which DOAC lysed a thrombus in an abdominal aortic aneurysm (AAA), resulting in impending rupture of the AAA. An 85-year-old woman was admitted to our hospital with a diagnosis of congestive heart failure. She has had atrial fibrillation and started taking DOAC. Computed tomography (CT) performed on admission revealed an AAA with a large amount of intraluminal thrombus (ILT). Fifty days after the start of DOAC, she visited our hospital with the chief complaint of severe abdominal pain. CT showed no enlargement of the AAA, but the ILT in the AAA had dissolved. She was diagnosed with an impending rupture of an AAA. She underwent emergency aortic replacement with a Y-shaped vascular prosthesis. When using DOAC in patients with aortic aneurysms with ILT, we need to be aware of the risk of the thrombus dissolving.