Rivaroxaban use during vitamin K₁ therapy for rodenticide poisoning

Management of severe anticoagulant rodenticide poisoning relies mainly on vitamin K₁ (VK₁) therapy, which often requires prolonged administration when long-acting anticoagulant rodenticides (LAARs) are involved.

Can a direct oral anticoagulant (DOAC) be safely reintroduced in a patient at high risk of thrombosis recurrence whose LAAR poisoning is being managed with prolonged VK₁ therapy?

We report the case of a patient receiving rivaroxaban for recurrent thrombosis who ingested massive amounts of brodifacoum, difenacoum, and difethialone over the course of 1 month. He developed severe VK-dependent coagulopathy (international normalized ratio, >26) with hematuria, necessitating discontinuation of rivaroxaban and initiation of intravenous, followed by long-term oral, VK₁ therapy. Rivaroxaban was successfully reintroduced under close clinical and laboratory monitoring after several days of ongoing oral VK₁ therapy.

This case demonstrates the feasibility of resuming DOAC therapy during VK₁ treatment after LAAR poisoning.