# Spontaneous Psoas Hematoma Following Resistance Training in an Elderly Patient on Apixaban: A Case Report

## TL;DR

An elderly man on apixaban developed a psoas hematoma after resistance training, highlighting risks of anticoagulants in older adults.

## Contribution

This case report emphasizes the need for cautious exercise counseling in elderly patients on direct oral anticoagulants.

## Key findings

- An 80-year-old male on apixaban developed a spontaneous psoas hematoma during hospitalization for pneumonia.
- The case underscores the risk of bleeding in older adults on anticoagulants engaging in physical activity.
- Clinicians should provide tailored exercise guidance to minimize injury risks in this population.

## Abstract

Regular physical activity, including resistance training, is strongly recommended for older adults to preserve muscle mass, balance, and functional independence. However, the increasing use of direct oral anticoagulants (DOACs), such as apixaban, in this population introduces important clinical considerations, particularly the risk of spontaneous bleeding in those participating in physical activity. Various scoring systems are used to create better judgement calls when initiating an anticoagulant, however initiating the anticoagulant is up to the discretion of the physician. We present the case of an 80-year-old male with multiple comorbidities, including atrial fibrillation managed on apixaban for anticoagulation, who was diagnosed with a spontaneous psoas hematoma during hospitalization for pneumonia. This case highlights the importance of a risk-aware approach to physical activity counseling in older adults on anticoagulation therapy. Clinicians must maintain a high index of suspicion and provide tailored exercise guidance to minimize injury risk. As the older population and use of DOACs continue to rise, increased awareness and surveillance are essential to promote safe physical activity in this vulnerable group.