A case of increasing hematoma over 5 days after adductor canal block associated with apixaban

Abstract

The decision to continue or discontinue apixaban, an oral inhibitor of blood coagulation factor Xa, before peripheral nerve block should be individualized. We encountered a case of extensive hematoma after adductor canal block (ACB) in a patient on oral apixaban. The patient was a 70-year-old woman who had persistent pain after left knee arthroplasty. She was taking apixaban for atrial fibrillation. The dose of apixaban was increased because she had venous thrombosis of the lower extremities after surgery. We performed an ultrasound-guided continuous ACB. Because of thrombosis, apixaban was continued before administering ACB. After ACB, we observed continuous bleeding from the insertion site and removed the catheter. However, the hematoma expanded from the adductor canal to her hip and knee. The bleeding was controlled within a week. In this case, the increased dose of apixaban for venous thrombosis and renal dysfunction increased the bleeding risk. ACB should be carefully considered for patients taking anticoagulants.