The X factor: Lack of bleeding after an acute apixaban overdose

We present an acute apixaban overdose without reported coingestants; it is the first such case report associated with multiple serum drug levels to assist in determining overdose kinetics. A 62 year old female presented to an emergency department (ED) 2 hours after ingesting sixty 5 mg tablets (5mg/kg) of her spouse's apixaban medication. She denied coingestants, and did not take her prescribed medications that day. Her vital signs were normal and she denied symptoms. Chemistry and hematology labs were unremarkable. Plasma apixaban concentrations were 2765.6 ng/ml at 14 hours post ingestion with a non-linear half life. There was no utilization of blood products or factor replacement. There was never any bleeding, and her hemoglobin did not decrease. This case demonstrates that a single ingestion of apixaban can occur without any complications occurring.