Servicio de Aparato Digestivo, Corporació Sanitària Universitària Parc Taulí. Universitat Autònoma de Barcelona, España.
Servicio de Aparato Digestivo, Corporació Sanitària Universitària Parc Taulí. Universitat Autònoma de Barcelona.
Rev Esp Enferm Dig. 2019 Feb;111(2):161-163. doi: 10.17235/reed.2018.5877/2018.
The use of new oral anticoagulants such as apixaban is increasing. We present the case of an 85-year-old patient who was diagnosed with mixed profile toxic hepatitis due to apixaban use. An etiological study was negative, except for anti-smooth muscle antibodies, and a liver biopsy ruled out autoimmune hepatitis. The patient was assigned a score of 7 on the CIOMS/RUCAM scale, indicating a probable causality. The liver injury improved after the withdrawal of apixaban. A previous meta-analysis reported that the risk of hepatotoxicity does not increase with the use of apixaban, nor were any cases reported in registry studies. Nonetheless, more than 120 possible cases currently appear in the European pharmacovigilance database (EudraVigilance). We suggest that apixaban should be considered as a possible cause of liver injury.
新型口服抗凝剂（如阿哌沙班）的应用正在增加。我们报告了一例 85 岁患者，因使用阿哌沙班而被诊断为混合表型中毒性肝炎。除了平滑肌抗体呈阳性外，病因学研究均为阴性，肝脏活检排除了自身免疫性肝炎。根据 CIOMS/RUCAM 量表，患者的评分为 7，提示可能存在因果关系。停用阿哌沙班后，肝损伤得到改善。此前的一项荟萃分析报告称，阿哌沙班的使用不会增加肝毒性风险，也没有在注册研究中报告过任何病例。尽管如此，目前在欧洲药物警戒数据库（EudraVigilance）中已经出现了超过 120 例疑似病例。我们建议将阿哌沙班视为肝损伤的一个可能原因。
