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Rapid Point-of-Care Assay of Enoxaparin Anticoagulant Efficacy in Whole Blood
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Massive Apixaban Overdose Confirmed with Blood Concentrations and Managed Without Bleeding: A Single Case Report
Elie Harmouche1, Peter Stueve2, Mary Ann Howland3,4
1Department of Emergency Medicine, Division of Medical Toxicology, Maimonides Medical Center, Brooklyn, NY, USA.
Journal of Pharmacy Practice
|May 25, 2023
Summary
A patient survived a massive apixaban overdose with no bleeding complications. This case highlights the importance of monitoring anticoagulant levels and managing overdose, even in the absence of immediate adverse events.
Area of Science:
- Pharmacology
- Internal Medicine
- Toxicology
Background:
- Direct oral anticoagulants (DOACs) like apixaban are increasingly prescribed.
- Patient outcomes following documented DOAC overdoses are rarely reported.
- Acute overdose of apixaban is uncommon but carries potential risks.
Purpose of the Study:
- To report a case of massive apixaban overdose.
- To describe patient outcomes and pharmacokinetic data after a significant apixaban ingestion.
- To contribute to the limited literature on apixaban overdose management.
Main Methods:
- A 76-year-old male ingested 60-70 apixaban pills.
- Emergency department presentation with laboratory tests and serial apixaban concentration monitoring.
- Administration of activated charcoal and fresh frozen plasma.
Main Results:
- Initial apixaban concentration was 4000 ng/mL, decreasing over 14 hours.
- Apixaban elimination followed first-order kinetics with a 14-hour half-life.
- The patient experienced no minor or major bleeding events despite a high INR (12).
Conclusions:
- Massive apixaban overdose can be managed without immediate bleeding complications.
- Apixaban elimination may be prolonged in patients with impaired renal function.
- This case emphasizes the need for careful monitoring in significant anticoagulant overdoses.
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