{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,25]],"date-time":"2026-04-25T09:58:08Z","timestamp":1777111088845,"version":"3.51.4"},"reference-count":14,"publisher":"Springer Science and Business Media LLC","issue":"1","license":[{"start":{"date-parts":[[2019,12,1]],"date-time":"2019-12-01T00:00:00Z","timestamp":1575158400000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2019,12,26]],"date-time":"2019-12-26T00:00:00Z","timestamp":1577318400000},"content-version":"vor","delay-in-days":25,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["J Med Case Reports"],"published-print":{"date-parts":[[2019,12]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec>\n<jats:title>Background<\/jats:title>\n<jats:p>Edoxaban is an orally administered anticoagulant treatment that is used in patients with cerebral infarction, venous thrombosis, or other conditions, with a reported incidence of gastrointestinal hemorrhage at approximately 1%. We encountered the rare case of a patient who developed a gallbladder hemorrhage after the administration of edoxaban.<\/jats:p>\n<\/jats:sec><jats:sec>\n<jats:title>Case presentation<\/jats:title>\n<jats:p>An 86-year-old Japanese woman visited our gastrointestinal department due to the chief complaint of melena lasting for a week. Her medical history included hypertension and embolic cerebral infarction, and she was taking orally administered carvedilol (5\u2009mg\/day) and edoxaban (30\u2009mg\/day). Her palpebral conjunctiva was pale during a physical examination, indicating the possibility of anemia. Her blood test results confirmed severe anemia with red blood cells at 1.7\u2009\u00d7\u200910<jats:sup>6<\/jats:sup>\/\u03bcL and hemoglobin at 4.7\u2009g\/dL. An upper gastrointestinal endoscopy revealed bile and fresh blood on the duodenal bulb and in more distal regions; hemobilia was suspected. A computed tomography scan on the ninth hospitalization day confirmed the hemobilia with a gallbladder fundus high-density signal. She was discharged on the 30th day of hospitalization with only fluid therapy and no progression of anemia. Moreover, she underwent a laparoscopic cholecystectomy 1 month after discharge, but the pathologist did not identify false aneurysms or neoplastic lesions. She has not been shown to develop anemia for 5\u2009months after surgery.<\/jats:p>\n<\/jats:sec><jats:sec>\n<jats:title>Conclusions<\/jats:title>\n<jats:p>Our case suggests that gallbladder hemorrhage needs to be considered a possible complication for patients on direct oral anticoagulants.<\/jats:p>\n<\/jats:sec>","DOI":"10.1186\/s13256-019-2328-9","type":"journal-article","created":{"date-parts":[[2019,12,26]],"date-time":"2019-12-26T01:02:14Z","timestamp":1577322134000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":13,"title":["Gallbladder hemorrhage during orally administered edoxaban therapy: a case report"],"prefix":"10.1186","volume":"13","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-6860-9734","authenticated-orcid":false,"given":"Hideya","family":"Itagaki","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Suzuki","family":"Katuhiko","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"297","published-online":{"date-parts":[[2019,12,26]]},"reference":[{"key":"2328_CR1","doi-asserted-by":"publisher","first-page":"358","DOI":"10.1002\/cpdd.53","volume":"2","author":"N Matsushima","year":"2013","unstructured":"Matsushima N, Lee F, Sato T, Weiss D, Mendell J. Bioavailability and safety of the factor XA inhibitor Edoxaban and the effects of quinidine in healthy subjects. Clin Pharmacol Drug Dev. 2013;2:358\u201366.","journal-title":"Clin Pharmacol Drug Dev"},{"key":"2328_CR2","doi-asserted-by":"publisher","first-page":"99","DOI":"10.1016\/j.ahj.2017.08.017","volume":"194","author":"K Okumura","year":"2017","unstructured":"Okumura K, Lip GY, Akao M, Tanizawa K, Fukuzawa M, Abe K, et al. Edoxaban for the management of elderly Japanese patients with atrial fibrillation ineligible for standard oral anticoagulant therapies: Rationale and design of the ELDERCARE-AF study. Am Heart J. 2017;194:99\u2013106.","journal-title":"Am Heart J"},{"key":"2328_CR3","doi-asserted-by":"publisher","first-page":"2093","DOI":"10.1056\/NEJMoa1310907","volume":"369","author":"RP Giugliano","year":"2013","unstructured":"Giugliano RP, Ruff CT, Braunwald E, Murphy SA, Wiviott SD, Halperin JL, et al. Edoxaban versus warfarin in patients with atrial fibrillation. N Engl J Med. 2013;369:2093\u2013104.","journal-title":"N Engl J Med"},{"key":"2328_CR4","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCOUTCOMES.117.003998","volume":"11","author":"J Aisenberg","year":"2018","unstructured":"Aisenberg J, Chatterjee-Murphy P, Friedman Flack K, Weitz JI, Ruff CT, et al. Gastrointestinal bleeding with Edoxaban versus Warfarin: Results from the ENGAGE AF-TIMI 48 trial (Effective Anticoagulation With Factor Xa Next Generation in Atrial Fibrillation-Thrombolysis In Myocardial Infarction). Circ Cardiovasc Qual Outcomes. 2018;11:e003998.","journal-title":"Circ Cardiovasc Qual Outcomes"},{"key":"2328_CR5","doi-asserted-by":"publisher","first-page":"790","DOI":"10.1097\/00000658-195005000-00018","volume":"131","author":"HH Kerr","year":"1950","unstructured":"Kerr HH, Mensh M, Gould EA. Biliary tract hemorrhage; a source of massive gastro-intestinal bleeding. Ann Surg. 1950;131:790\u2013800.","journal-title":"Ann Surg"},{"key":"2328_CR6","doi-asserted-by":"publisher","first-page":"146","DOI":"10.1016\/S1726-4901(09)70237-0","volume":"68","author":"SW Tan","year":"2005","unstructured":"Tan SW, Lai SK, Ng KW, Chen P, Chen KH, Jiang CF. Intramural gallbladder hematoma mimicking gallbladder neoplasm in a 33-year-old male. J Chin Med Assoc. 2005;68:146\u20139.","journal-title":"J Chin Med Assoc"},{"key":"2328_CR7","doi-asserted-by":"publisher","first-page":"438","DOI":"10.1056\/NEJM194603282341304","volume":"234","author":"PB Hudson","year":"1946","unstructured":"Hudson PB, Johnson PP. Hemorrhage from the gall bladder. N Engl J Med. 1946;234:438\u201341.","journal-title":"N Engl J Med"},{"key":"2328_CR8","doi-asserted-by":"publisher","first-page":"203","DOI":"10.1159\/000135693","volume":"2","author":"DS Morris","year":"2008","unstructured":"Morris DS, Porterfield JR, Sawyer MD. Hemorrhagic cholecystitis in an elderly patient taking aspirin and cilostazol. Case Rep Gastroenterol. 2008;2:203\u20137.","journal-title":"Case Rep Gastroenterol"},{"key":"2328_CR9","doi-asserted-by":"publisher","unstructured":"Kinnear N, Hennessey DB, Thomas R. Haemorrhagic cholecystitis in a newly anticoagulated patient. BMJ Case Rep. 2017;2017: pii: bcr-2016-214617 https:\/\/doi.org\/10.1136\/bcr-2016-214617.","DOI":"10.1136\/bcr-2016-214617"},{"key":"2328_CR10","doi-asserted-by":"publisher","first-page":"313","DOI":"10.7863\/jum.1987.6.6.313","volume":"6","author":"DH Chinn","year":"1987","unstructured":"Chinn DH, Miller EI, Piper N. Hemorrhagic cholecystitis. Sonographic appearance and clinical presentation. J Ultrasound Med. 1987;6:313\u20137.","journal-title":"J Ultrasound Med"},{"key":"2328_CR11","doi-asserted-by":"publisher","first-page":"1203","DOI":"10.1016\/S0033-8389(03)00097-6","volume":"41","author":"GL Bennett","year":"2003","unstructured":"Bennett GL, Balthazar EJ. Ultrasound and CT evaluation of emergent gallbladder pathology. Radiol Clin North Am. 2003;41:1203\u201316.","journal-title":"Radiol Clin North Am"},{"key":"2328_CR12","doi-asserted-by":"publisher","first-page":"3","DOI":"10.1002\/jhbp.518","volume":"25","author":"H Gomi","year":"2018","unstructured":"Gomi H, Solomkin JS, Schlossberg D, Okamoto K, Takada T, Strasberg SM, et al. Tokyo Guidelines 2018: Antimicrobial therapy for acute cholangitis and cholecystitis. J Hepatobiliary Pancreat Sci. 2018;25:3\u201316.","journal-title":"J Hepatobiliary Pancreat Sci"},{"key":"2328_CR13","doi-asserted-by":"publisher","first-page":"615","DOI":"10.1056\/NEJMoa1711948","volume":"378","author":"GE Raskob","year":"2018","unstructured":"Raskob GE, van Es N, Verhamme P, Carrier M, Di Nisio M, Garcia D, et al. Edoxaban for the treatment of cancer-associated venous thromboembolism. N Engl J Med. 2018;378:615\u201324.","journal-title":"N Engl J Med"},{"key":"2328_CR14","doi-asserted-by":"publisher","first-page":"432","DOI":"10.5090\/kjtcs.2015.48.6.432","volume":"48","author":"SH Cho","year":"2015","unstructured":"Cho SH, Lee HY, Kim HS. Anticoagulant therapy-induced gallbladder hemorrhage after cardiac valve replacement. Korean J Thorac Cardiovasc Surg. 2015;48:432\u20134.","journal-title":"Korean J Thorac Cardiovasc Surg"}],"container-title":["Journal of Medical Case Reports"],"original-title":[],"language":"en","link":[{"URL":"http:\/\/link.springer.com\/content\/pdf\/10.1186\/s13256-019-2328-9.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"http:\/\/link.springer.com\/article\/10.1186\/s13256-019-2328-9\/fulltext.html","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"http:\/\/link.springer.com\/content\/pdf\/10.1186\/s13256-019-2328-9.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2020,12,25]],"date-time":"2020-12-25T00:24:50Z","timestamp":1608855890000},"score":1,"resource":{"primary":{"URL":"https:\/\/jmedicalcasereports.biomedcentral.com\/articles\/10.1186\/s13256-019-2328-9"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2019,12]]},"references-count":14,"journal-issue":{"issue":"1","published-print":{"date-parts":[[2019,12]]}},"alternative-id":["2328"],"URL":"https:\/\/doi.org\/10.1186\/s13256-019-2328-9","relation":{},"ISSN":["1752-1947"],"issn-type":[{"value":"1752-1947","type":"electronic"}],"subject":[],"published":{"date-parts":[[2019,12]]},"assertion":[{"value":"28 October 2019","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"29 November 2019","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"26 December 2019","order":3,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"The Honjou Daiichi Hospital ethics committee approved this study.","order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethics approval and consent to participate"}},{"value":"We obtained a written informed consent from the patient for publication of this case report and any accompanying images. A copy of the written consent is available for review by the Editor-in-Chief of this journal.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Consent for publication"}},{"value":"The authors declare that they have no competing interests.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Competing interests"}}],"article-number":"383"}}