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Massive intoxication with rivaroxaban, phenprocoumon, and diclofenac: A case report
Hella Pfeiffer1, Larissa Herbst, Bernd Schwarze
1Transfusion Medicine and Hemostaseology Department Department of Internal Medicine 4 Department of Forensic Medicine, University Hospital Erlangen, Erlangen, Germany.
Rationale:
Oral anticoagulants and painkillers, some with an additional effect on the coagulation system, are widely used and are therefore prone to abuse and (intentional) overdose. We report the case of a patient with a massive mixed anticoagulant intoxication.
Patient Concerns:
The patient had ingested 1960 mg rivaroxaban, 31.5 mg phenprocoumon, 1425 mg diclofenac, and 21,000 mg metamizole in suicidal intention.
Diagnoses:
Massive mixed anticoagulant overdose.
Interventions:
The patient was closely monitored. The phenprocoumon overdose was treated by the administration of vitamin K and PCC.
Outcomes:
Despite the massive inhibition of the coagulation system, the patient did not experience bleeding apart from a slight gross hematuria.
Lessons:
Despite the ingestion of a massive amount of rivaroxaban, the plasma levels were not as high as feared, due to the ceiling effect of rivaroxaban absorption. Elimination occurred according to the half-life of rivaroxaban and was not unduly prolonged by the ingested quantity.
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