Could direct-acting oral anticoagulant be a possible cause of delayed pseudoaneurysm? A case report

Delayed iatrogenic pseudoaneurysm (IPA) is very rare. We aimed to present a case of delayed femoral IPA using apixaban, which developed four months after coronary intervention (PCI). A 75-year-old female patient who had PCI four months ago presented with right femoral artery IPA that started one month ago, with no recent history of trauma, infection, or new procedures, except for diabetes and apixaban use. The occurrence of IPA at the insertion site four months after the initial procedure is an infrequent complication. Delayed IPA risk factors are trauma, infection, anticoagulant use, and inflammatory disease. Since no other risk factor was found in our case, the cause of IPA seems to be apixaban. Our case highlights the importance of considering delayed IPA as a potential complication, which may manifest up to four months after the initial procedure, especially in diabetic patients who are on anticoagulant therapy.