Faculty, Staff and Student Publications

Language

English

Publication Date

11-1-2021

Journal

Cureus

DOI

10.7759/cureus.19688

PMID

34934565

PMCID

PMC8683972

PubMedCentral® Posted Date

November 2021

PubMedCentral® Full Text Version

Post-print

Abstract

Direct oral anticoagulants (DOACs) drug-to-drug interactions are underrecognized by clinicians. Apixaban has cytochrome 450 (CYP) mediated metabolism (primarily by CYP3A4). Strong inducers and inhibitors of this enzyme may cause variations in the blood level of apixaban. This report presents a patient who received a femoral artery stent and developed a large retroperitoneal hemorrhage after she was prescribed apixaban in addition to her antiretroviral therapy (AVT) regimen that included cobicistat, a strong CYP3A4 inhibitor. The patient was managed conservatively, and a repeat computed tomography scan in a subsequent admission revealed near resolution of the hematoma. The treating physicians realized that apixaban should not be prescribed with a potent CYP3A4 inhibitor like cobicistat and discontinued it.

Keywords

apixaban; cobicistat; cyp3a4 inhibitor; cytochrome 450; drug interaction; hiv; vascular procedure.

Published Open-Access

yes

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