Background: Apixaban is a direct and competitive inhibitor of factor Xa. It has been shown to be effective and safe to Prevent Stroke in Atrial Fibrillation Patients. This study is a case report of warfarin-induced cholestasis that occurred one week after starting warfarin for deep venous thrombosis, in which the cholestasis improved after the offending drug was stopped but worsened after beginning apixaban.
Case Presentation: We presented a case of 79-year-old woman, she was presented to the emergency depart¬ment with a chief complaint of left lower limb swelling of 3 days duration. On physical examination, her left lower limb was swollen, warm, and tender. Venous Doppler ultrasound showed extensive deep venous throm¬bosis and anticoagulation with unfractionated heparin and warfarin 7 mg initiated.
Conclusion: Apixaban should be avoided in patients with warfarin-induced cholestasis.
Key words: Warfarin, apixaban, hepatotoxicity, anticoagulant, thrombosis, case report.