Anti-Xa activity in apixaban overdose: a case report

Area of Science:

• Pharmacology
• Toxicology
• Clinical Medicine

Background:

• Apixaban is a direct factor Xa inhibitor used for anticoagulation.
• Overdose cases are rare, necessitating understanding of its pharmacokinetic profile.

Observation:

• A 53-year-old male ingested 200 mg of apixaban along with multiple other medications and alcohol.
• He developed hypotension requiring noradrenaline and presented with a peak apixaban concentration of 1022.6 ng/ml.
• Minor bleeding at a central line site resolved with compression; Vitamin K and Prothrombinex-VF had no effect.

Findings:

• Apixaban elimination followed first-order kinetics with a half-life of 7.4 hours.
• Plasma apixaban levels normalized to therapeutic range within 10 hours post-ingestion.
• No significant bleeding complications occurred despite high apixaban concentrations.

Implications:

• This case provides valuable data on apixaban pharmacokinetics in overdose.
• Current reversal agents may not be effective for apixaban-induced anticoagulation.
• Understanding apixaban elimination is crucial for managing overdose scenarios.