We report the case of a 75-year old man heart failure (HF) with reduced left ventricular ejection fraction (LVEF) in established ischemic heart disease . He also suffered from type 2 diabetes, complicated by chronic kidney disease (CKD), peripheral neuropathy, and retinopathy causing multiple intraocular hemorrhages. Before coming to our attention, he had received intravitreal injections of bevacizumab, an anti-vascular endothelial growth factor antibody, for his retinal disease. A few months before our first evaluation, another intraocular hemorrhage had occurred.
Electrocardiogram, however, newly-discovered revealed AF with normal heart rate. Serum creatinine was 2.7 mg/dL, the estimated glomerular filtration rate (eGFR) being 22 mL/min/1.73 m2.
The patient was suggested to start warfarin instead of acetilsalicic acid, which he had been taken for ischemic heart disease, but he refused because of the fear of intraocular bleeding. Considering the high risk of cardioembolism, we then proposed edoxaban at the reduced dose.

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