Key result
A massive acute rivaroxaban overdose (1940 mg) in a 71-year-old man was successfully managed with conservative therapy alone, resulting in no major bleeding events.
Case Report (n=1)
No
Conservative management without reversal agents may be sufficient for massive acute rivaroxaban overdose in patients with normal renal function and no active bleeding.
May support conservative management of massive rivaroxaban overdose; hypothesis-generating and should not yet change practice.
BACKGROUND: Since intentional overdose with rivaroxaban is expected to lead to significant coagulopathy and bleeding, prophylactic reversal has been suggested. We report a single massive ingestion confirmed by a blood concentration that was managed with expectant therapy alone. CASE REPORT: A 71-year-old man with atrial fibrillation, aortic valve replacement, and congestive heart failure presented to the emergency department after an intentional ingestion of 97 (1940 mg total) rivaroxaban tablets in a suicide attempt. Initial laboratories revealed: PT, 60.2 s; INR 7.2; aPTT, 55.7 s; BUN 28 mg/dL; and creatinine 1.2 mg/dL. A whole-blood rivaroxaban concentration obtained on hospital-day three was 160 ng/mL. The patient was admitted for continued observation and the coagulation markers trended downward with no major bleeding events. No reversal agents or blood products were given during his hospitalization. CONCLUSION: In the setting of a single, acute rivaroxaban overdose, with normal renal function, and no active bleeding, conservative therapy alone may be sufficient.
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Repplinger et al. (2016) conducted a case report in Rivaroxaban overdose (n=1). Acute rivaroxaban overdose was evaluated on Major bleeding events. A massive acute rivaroxaban overdose (1940 mg) in a 71-year-old man was successfully managed with conservative therapy alone, resulting in no major bleeding events.
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