Direct Oral Anticoagulant after Bleeding Event in Deep Vein Thrombosis: A Case Report A. S. Suhendro'; J. W. Martha’ ‘Department of Cardiology and Vascular Medicine, Faculty of Medicine Universitas Padjadjaran - Hasan Sadikin General Hospital, Bandung, Indonesia Venous Thromboembolism (VTE) ie the third common caure of cardiovascular death. Anticoagulation i the cornerstone of VIE trectment but bleeding i sl the moin adverse events. Bleeding is he most commen complication of enticoaguletin and should be menaged rapidly based on hemodynamic instil, source of bleeding, and degree of blood loss We present o case of incoclcr bleeding after cnticoaguation for Deep Vein Thrombosis (DVT) ‘A 26.yearld female, mown at Autoimmune Hemolytic Anemia and routinely visting hemato-oncology outpatient clini, was referred 19 ‘emergency department with unilateral swelling of lower extremity for ‘0 week. She also Felt pein and numbnes inthe right lower extremity. Pein wos felt at rest and by any movement or change in postion. She also hed history of swelling in right lower extramity that poctly treated. ‘She also hed a wound inthe pretibial area for 6 months. The vital sign is stable wit onemic conjunctiva, icterle slerae, and hepatosplenamegaly ‘he calf diometer of right lower extremity is 4.5.cm bigger than the ‘other side with venous uler in pretibial area. ECG examinction showed sinus tachycardia. The laboratory examinotion showed an elevated D-Dimer level. Wells score was colevlated with score of 5 (DVT Likely) ‘Complete Vasculor Utrasonogrephy was performed with compression ‘itraroune (CUS) poriive in the right femoral vein and right grect sophenovs vein. Patient war diagnosed with Deep Vein Thrombosis of Right Lower Extremity with Venous Uleer end was reated with Enoxaparin £60 mg twice daily, During hospitalization, she complained of abruptly blurted vision. Opthoimolog)st wes consulted and she was diagnosed ‘with intraretinal hemorthage. The platelet level wos also decreased more than 096. Thus, she wos diagnosed with Heparin Induced Thrombocytopenia, LMWH was topped. Vena cove filer should be an option in his patent, but the resources were scarce. Four days after bleeding events, The patient Vision was improved, with no active itraratinal bleeding from ophihelne- scopic examination, s0 anticoagulant wes restarted using Rivaroxeben 15 mg ‘ice deily. Three days after, she was discharged with no sign of bleeding or worsening vision ond the platelet level is increased — 1017000 ie iangircccnas ae ‘Anticoagulant therapies can lead to bleeding complietions that uneasy to tect. The physicien should do a rapid ond careful ‘osierment of the source couse and severity of the bleeding. (Our patient wor diagnosed of having lnrcretinal haemorrhage ‘with peripopillary haemorthage whichis @ major bleeding ceccording to International Society of Thrombosis and Hemostasis, Direct eral caticoagulans (DOACs have & comparable eficocy in proventing recurent VTE and evperiorrofety profil thon LUAWH/VKA therapy. Major bleeding risk in 6-month treatment with DOACS wes only 1.1% with @eate-fatalty rate of 5.3% compared fo LAWH/VKA treatment wih 1.7% rsk of major bleeding and 10% case-fotality rate. A systematic review ond rmeto-cnaiysishad stated thot OOACE have a lower rate of maior bleeding, poriulary intraocular bleeding when compared to porenteral therapy and Vitemin K Antagonist However, no Meroture stated ebeut timing 10 reintiting antitvombetic reetment cofterintrocculer bleeding. The decision to restart aniccegulant therepy should be balancing the risk and benefit of preventing thromboembolic and bleeding rik Drees ovrioceonra tere Make srt Sone isn to eos etait! tag oso Ane GA a Hee 207,15 Ce in