Why the study?
With the increasing use and potential abuse of direct oral anticoagulants like rivaroxaban, standardization of care for misuse must be explored, particularly because there is limited information and no documented cases of ingestion reaching 5,000 mg with severe bleeding.
This case report documents the management of an unprecedented 5,000 mg rivaroxaban overdose presenting with severe bleeding.
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Supports andexanet alfa use in extreme rivaroxaban overdose; leaves open standardized protocols.
Direct oral anticoagulants (DOACs) have been used more frequently for the prevention and management of thromboembolic disease in comparison to their predecessors. DOACs provide greater ease of administration, shorter half-lives, less monitoring, and fewer drug-drug interactions. With the rise of DOACs such as rivaroxaban, the opportunity for abuse also increases. Therefore, standardization of care based on rivaroxaban misuse must also be explored, an area in which there is not ample information. We present a case where a patient consumed a stockpile of her home medications in hopes to commit suicide. A 64-year-old female presented to the emergency department due to the ingestion of rivaroxaban 5,000 mg along with ingestion of acetaminophen 30,000 mg and isosorbide mononitrate 1000 mg in the setting of intentional self-harm with multiple declarations of being classified as Do Not Resuscitate. There have been documented cases of rivaroxaban overdose, however, there are no documented cases with levels of ingestion reaching 5,000 mg along with signs of severe bleeding. Our case study reviews the previously documented management of rivaroxaban abuse and the treatment that was given to our patient in the setting of extreme anticoagulant ingestion.
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Casey et al. (2023) studied this question.
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