Spontaneous Suprachoroidal Hemorrhage in a Patient on Apixaban: A Case Report

We, herein, present a rare case report evaluating an elderly patient who developed spontaneous suprachoroidal hemorrhage (SSCH) while using apixaban (direct oral anticoagulant agent).

An 82-year-old man with a known history of hypertension and atrial fibrillation on apixaban presented with a sudden onset of flashes, floaters, and a temporal curtain-like visual field defect in his right eye. He had no preceding history of trauma or recent ocular surgery. Ophthalmological examination revealed two large elevated grayish choroidal lesions with associated exudative retinal detachment. Ultrasonography and wide-field fluorescein angiography confirmed the diagnosis of SSCH. The patient was managed with topical steroids and cyclopentolate. One month later, the vision improved, and the hemorrhage showed signs of resolution.

Direct oral anticoagulant agents (DOACs) are safer and carry a lower risk of major bleeding events compared to the traditionally used antiplatelet therapy and thrombolytic agents; however, patients may still be at risk of spontaneous suprachoroidal hemorrhage.

Spontaneous suprachoroidal hemorrhage can very rarely occur with the use of DOACs, with only two cases reported in the literature, and here, we present a case of SSCH in a patient while using apixaban.