Novel oral anticoagulant induced upper limb haematoma: A case report

The development of novel oral anticoagulant agents (NOACs) such as dabigatran, rivaroxaban, apixaban and edoxaban has given patients better treatment alternatives to aspirin, clopidogrel, heparin and warfarin, mainly for stroke prophylaxis in patients with non-valvular atrial fibrillation (NVAF), prophylaxis/treatment of venous thromboembolism (VTE) and also for the secondary prophylaxis of acute coronary syndromes. These agents are gaining in popularity due to their more stable pharmacokinetic profile, fewer drug interactions, as well as eliminating the need for routine monitoring. NOAC induced haematomas of the upper limb are rare and there is no real consensus on management. We present a case of a 70-year-old male on rivaroxaban who developed a delayed onset intramuscular forearm haematoma after a simple fall onto his left arm. Simple elevation of the limb was successful in leading to resolution of symptoms. As these agents increase in popularity, clinicians need to be more aware of potential risks of treatment and subsequent management.