17th INTERNATIONAL MEDICINE AND HEALTH SCIENCES RESEARCHERS CONGRESS
Massive Pectoral Muscle Hemorrhage Associated With Edoxaban Use
ntroduction: In bedridden patients, repositioning is often performed by family members or caregivers under close supervision. Edoxaban, a direct factor Xa inhibitor, is commonly prescribed for atrial fibrillation, which is associated with a low risk of bleeding. This case highlights the significance of proper repositioning in bedridden patients. Case Report: An 89-year-old male patient with Alzheimer's disease, hypertension, and atrial fibrillation, managed with edoxaban (Lixiana), presented to the emergency department with a mass in the left pectoral region that developed over one month. The patient, bedridden and repositioned by family members at home, had no history of trauma or falls. On examination, a tense, rubbery mass approximately 60*140 mm was palpated in the left pectoral area. A chest MRI revealed a heterogeneous hematoma, 136*62 mm, beneath the pectoral muscle and overlying the intercostal muscles. A chest CT performed one month earlier showed the initial hematoma formation in the axillary region. Edoxaban (Lixiana) was discontinued, and after one week, following the cessation of its effects, approximately 200 ml of organized hematoma was drained through a minimal 2 cm skin incision under sedation and analgesia. Follow-up showed complete recovery. Discussion: Anticoagulants can be categorized by their bleeding risk into low and high-risk groups. In our patient, repeated repositioning with slight traction on the left arm caused friction in the pectoral muscle vessels, which, combined with the anticoagulant effect of edoxaban, led to hematoma progression over a month. Even with drugs like edoxaban, which are considered low-risk for bleeding, repetitive movements in specific body areas can result in prolonged and progressive hemorrhage. This case underscores the importance of careful monitoring and repositioning in bedridden patients, especially those on anticoagulant therapy.
