Angioedema Involving the Larynx after Starting Apixaban

A ngioedema is characterized by subcutaneous nonpitting edema of the skin, mucosal membranes, or both. It is often anatomically limited to subsites of the head and neck, which can be life threatening because of its sudden onset and airway compromise. Although angioedema has many known causes, including medications and environmental exposures, the etiology of acquired angioedema is often difficult to ascertain. Angioedema can be unpredictable and must be recognized without delay by identifying the characteristic clinical presentation and history. Apixaban is a direct factor Xa inhibitor used for venous thromboembolism and stroke prophylaxis in patients with atrial fibrillation. A single case report presented as an abstract at the International Academy of Cardiology Annual Science Session in 2014 discussed a patient with apixabanassociated angioedema and identified 6 other reported cases. However, these 6 other cases were described on a nonvalidated website. Angioedema has been reported to be associated with rivaroxaban, another factor Xa inhibitor. In this report, we present a rare case of acute angioedema and airway compromise without urticaria after starting apixaban for anticoagulation.