Related Experiment Video
Updated: Oct 2, 2025
11:17
Rapid Point-of-Care Assay of Enoxaparin Anticoagulant Efficacy in Whole Blood
Published on: October 12, 2012
14.0K
Two Cases of Acute Direct Oral Anticoagulant Overdose Without Adverse Effect
Catherine J Ha1, Elie Harmouche2, Mary Ann Howland3,4
1Columbia University Vagelos College of Physicians and Surgeons.
Journal of Pediatric Hematology/Oncology
|February 24, 2022
Summary
Two pediatric patients overdosed on direct oral anticoagulants (DOACs) but recovered without bleeding or needing reversal agents. A standard heparin anti-Factor Xa assay showed correlation with rivaroxaban levels, suggesting its potential utility.
Area of Science:
- Pediatric Pharmacology
- Clinical Toxicology
- Pharmacokinetics
Background:
- Direct oral anticoagulants (DOACs) are increasingly used for anticoagulation.
- Accidental overdoses in children present unique management challenges.
- Assessing DOAC levels in overdose is crucial but often difficult due to assay limitations.
Purpose of the Study:
- To describe the clinical management of pediatric patients with acute DOAC overdose.
- To evaluate the utility of a routine heparin anti-Factor Xa assay in a pediatric DOAC overdose case.
Main Methods:
- Case report of two pediatric patients with acute DOAC overdose.
- Conservative management including supportive care.
- Laboratory analysis using a routine hybrid heparin anti-Factor Xa assay.
Main Results:
- Both patients were managed conservatively without major or minor bleeding.
- Neither patient required reversal agents or blood products.
- A linear correlation was observed between serum rivaroxaban concentration and the heparin anti-Factor Xa assay up to 940 ng/mL.
Conclusions:
- Conservative management can be effective for pediatric DOAC overdose.
- Routine coagulation studies are insufficient for monitoring DOAC therapy or overdose.
- A standard heparin anti-Factor Xa assay may offer a practical alternative for estimating DOAC levels when specific assays are unavailable.
Related Concept Videos
01:18Anticoagulant Drugs: Vitamin K Antagonists and Direct Oral Anticoagulants
1.4K
Oral anticoagulants are vital tools in preventing and treating blood clotting disorders. This diverse class of medications can be categorized as vitamin K antagonists, exemplified by warfarin, and direct thrombin inhibitors (DTIs), such as dabigatran, as well as factor Xa inhibitors, including rivaroxaban.
Warfarin, a prominent vitamin K antagonist family member, exerts its effect by inhibiting the enzyme VKORC1 (vitamin K epoxide reductase complex 1). By hindering this enzyme, warfarin...
Warfarin, a prominent vitamin K antagonist family member, exerts its effect by inhibiting the enzyme VKORC1 (vitamin K epoxide reductase complex 1). By hindering this enzyme, warfarin...
1.4K
01:30Anticoagulant Drugs: Low-Molecular-Weight Heparins
972
Hemostasis is a crucial process that prevents excessive blood loss from damaged blood vessels. It involves various mechanisms such as vasoconstriction, platelet adhesion and activation, and fibrin formation. The importance of each mechanism depends on the type of vessel injury. In contrast, thrombosis is the abnormal formation of a blood clot within the blood vessels, leading to potential complications if the clot obstructs blood flow. Thrombosis can be caused by increased coagulability of the...
972
01:14Prevention of Further Absorption of Poison
950
In cases of acute poisoning, the primary objective is to prevent further absorption of the toxic substance into the body. Immediate interventions using various decontamination techniques targeting the gastrointestinal (GI) tract can achieve this. Decontamination is crucial to prevent poison from entering the systemic circulation, which involves washing affected areas with water and mild soap and removing contaminated clothing. Once external decontamination is done, attention must be turned to...
950
01:26Anticholinesterase Agents: Poisoning and Treatment
1.1K
Anticholinesterases, also known as cholinesterase inhibitors, work by blocking the breakdown of acetylcholine, leading to its accumulation in the synaptic cleft. This accumulation indirectly enhances both muscarinic and nicotinic actions. These agents are classified as reversible or irreversible based on their mechanism of action.
Irreversible agents form a strong bond with the cholinesterase enzyme, making it inactive. The breakdown of the phosphorylated enzyme is...
Irreversible agents form a strong bond with the cholinesterase enzyme, making it inactive. The breakdown of the phosphorylated enzyme is...
1.1K
01:29Venous Thrombosis III: Interprofessional Care
43
Venous thrombosis requires effective prevention and treatment strategies to improve patient outcomes and reduce potential complications.Prevention StrategiesHealthcare providers must prioritize preventing venous thromboembolism (VTE) for all adult patients upon admission. Interventions depend on bleeding and thrombosis risk, medical history, current medications, diagnoses, planned procedures, and patient preferences. Patients on bed rest should change positions every two hours and, if not...
43
01:17Antidotes
791
Antidotes are medicinal substances used to counteract the harmful effects of toxins or drugs in the body. They function in various ways, each uniquely designed to combat specific toxic compounds.
Specific antidotes operate by inhibiting the enzymes that control biochemical pathways, reducing the production of harmful metabolites.
An example of an antidote is atropine, which counteracts the detrimental effects of cholinesterase inhibitors. It achieves this by deactivating muscarinic receptors,...
Specific antidotes operate by inhibiting the enzymes that control biochemical pathways, reducing the production of harmful metabolites.
An example of an antidote is atropine, which counteracts the detrimental effects of cholinesterase inhibitors. It achieves this by deactivating muscarinic receptors,...
791