Fatal Nonvariceal Gastrointestinal Bleeding in a Cirrhotic Patient Taking Apixaban with No History of Hemorrhage

This report describes a cirrhotic female patient with no history of bleeding or other gastrointestinal disorder who experienced fatal gastrointestinal bleeding (GIB) after taking apixaban [which is a direct oral anticoagulant (DOAC)] for one month for management of chronic nonvalvular atrial fibrillation. The use of apixaban, coupled with the predilection for hemorrhage in cirrhotic patients, most likely contributed to her fatal GIB. Caution should be exercised in considering apixaban and potentially other members of the DOAC class for the treatment of cirrhotic patients until further research can explore the safety of DOAC therapy in cirrhotic patients.