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Past medical history was significant for longstanding atrial fibrillation for which he was taking apixaban 2.5\u2009mg twice daily. A CT scan of the abdomen and pelvis was performed which showed a 21\u00d711\u2009cm rectus sheath haematoma on the right extending into the lumbar region. Surgical review advised no invasive intervention. Two units of red cell concentrate were transfused and he was monitored for 5\u2009days before being transferred back to the nursing home.<\/jats:p>","DOI":"10.1136\/bcr-2022-254313","type":"journal-article","created":{"date-parts":[[2023,11,22]],"date-time":"2023-11-22T12:30:59Z","timestamp":1700656259000},"page":"e254313","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":2,"title":["Spontaneous rectal sheath bleed while on DOAC anticoagulation"],"prefix":"10.1136","volume":"16","author":[{"given":"Louis","family":"de Courcy","sequence":"first","affiliation":[{"name":"General Medicine, Midland Regional Hospital Portlaoise, Portlaoise, Ireland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"John","family":"Connaughton","sequence":"additional","affiliation":[{"name":"Internal Medicine, Midland Regional Hospital Portlaoise, Portlaoise, Ireland"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2023,11,22]]},"reference":[{"key":"2025082708410659000_16.11.e254313.1","doi-asserted-by":"crossref","first-page":"231","DOI":"10.1160\/TH14-06-0484","article-title":"Benefit-risk profile of non-vitamin K antagonist oral anticoagulants in the management of venous thromboembolism","volume":"113","author":"Beyer-Westendorf","year":"2015","journal-title":"Thromb Haemost"},{"key":"2025082708410659000_16.11.e254313.2","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(13)62343-0"},{"key":"2025082708410659000_16.11.e254313.3","doi-asserted-by":"crossref","first-page":"148","DOI":"10.1016\/j.amj.2016.01.001","article-title":"Emergent bleeding in patients receiving direct oral anticoagulants","volume":"35","author":"Summers","year":"2016","journal-title":"Air Med J"},{"key":"2025082708410659000_16.11.e254313.4","doi-asserted-by":"crossref","first-page":"1339","DOI":"10.1002\/pds.5317","article-title":"Major bleeding in users of direct oral anticoagulants in atrial fibrillation: a pooled analysis of results from multiple population-based cohort studies","volume":"30","author":"van den Ham","year":"2021","journal-title":"Pharmacoepidemiol Drug Saf"},{"key":"2025082708410659000_16.11.e254313.5","doi-asserted-by":"crossref","first-page":"1007","DOI":"10.1016\/j.jamcollsurg.2021.02.016","article-title":"Delayed intracranial hemorrhage after blunt head trauma while on direct oral anticoagulant: systematic review and meta-analysis","volume":"232","author":"Puzio","year":"2021","journal-title":"J Am Coll Surg"},{"key":"2025082708410659000_16.11.e254313.6","first-page":"1","article-title":"New agents for DOAC reversal: a practical management review","volume":"29","author":"White","year":"2022","journal-title":"Br J Cardiol"},{"key":"2025082708410659000_16.11.e254313.7","doi-asserted-by":"publisher","DOI":"10.1002\/clc.22435"},{"key":"2025082708410659000_16.11.e254313.8","doi-asserted-by":"publisher","DOI":"10.1016\/j.ahj.2005.04.017"},{"key":"2025082708410659000_16.11.e254313.9","unstructured":"Agency for Healthcare Research and Quality . 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