Key result
A deliberate overdose of 200 mg apixaban resulted in a peak concentration of 1022.6 ng/ml with only minor bleeding, displaying an elimination half-life of 7.4 hours and uneventful recovery.
Case Report (n=1)
No
In a massive apixaban overdose, elimination followed first-order kinetics with a 7.4-hour half-life, and the patient recovered without severe bleeding despite no demonstrable benefit from clotting factor replacement.
Apixaban overdose may cause only minor bleeding despite high levels; hypothesis-generating and should not yet change practice.
INTRODUCTION: Apixaban is a novel oral anticoagulation agent that exerts its effect through direct factor Xa inhibition. We present a case of multi-drug overdose including apixaban with associated apixaban concentrations. CASE: A 53 year-old man presented to our metropolitan hospital following a deliberate self-poisoning with 200 mg apixaban, 35 mg ramipril, 105 mg bisoprolol, 280 mg atorvastatin, 6 mg colchicine, 37.4 mg magnesium, 4 × 500 mg paracetamol/9.5 mg codeine/5 mg phenylephrine and alcohol. He developed hypotension that was treated with noradrenaline. His initial and peak apixaban concentration was 1022.6 ng/ml and was associated with only minor bleeding from his femoral central line insertion site, which improved with local compression. Vitamin K 10 mg (at 9 h post-ingestion) and Prothrombinex-VF 2000 units (at 13 h post-ingestion) were also administered without any observed effect on coagulation studies. Apixaban elimination appeared to display first-order kinetics with an elimination half-life of 7.4 h. His plasma apixaban concentration was within the therapeutic dose range 10 h post-ingestion and he recovered uneventfully. CONCLUSION: A case of apixaban overdose with associated apixaban concentrations is presented. There was rapid resolution of anticoagulation with no demonstrable benefit of currently available clotting factor replacement.
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Barton et al. (2016) conducted a case report in Apixaban overdose (n=1). Apixaban overdose was evaluated on Apixaban concentration and clinical outcome. A deliberate overdose of 200 mg apixaban resulted in a peak concentration of 1022.6 ng/ml with only minor bleeding, displaying an elimination half-life of 7.4 hours and uneventful recovery.
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