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Accidental Rivaroxaban Intoxication in a 25-month-old Child Monitored by Thromboelastography: A Case Report

Keita Nakanishi1, Shota Yamasaki2, Yuna Watanabe1

  • 1Department of Pediatrics, Akashi Medical Hospital, Hyogo, Japan.

The Kobe Journal of Medical Sciences
|February 19, 2026
PubMed

Insights

A child accidentally ingested a large dose of rivaroxaban. Thromboelastography (TEG® 6s) monitoring showed coagulation function normalized within 20 hours, indicating its usefulness in pediatric cases.

Area of Science:

  • Pediatric Emergency Medicine
  • Pharmacology
  • Clinical Coagulation

Background:

  • Rivaroxaban is a direct-acting factor Xa inhibitor.
  • Thromboelastography (TEG® 6s) assesses coagulation, often used perioperatively.
  • Limited data exists on TEG® 6s in pediatric rivaroxaban overdose.

Purpose of the Study:

  • To report a case of pediatric rivaroxaban ingestion.
  • To evaluate the utility of TEG® 6s in monitoring coagulation after overdose.
  • To assess the safety and recovery profile in a child.

Main Methods:

  • Case report of a 25-month-old girl with accidental rivaroxaban ingestion.
  • Continuous coagulation monitoring using TEG® 6s.
  • Clinical observation for bleeding events.

Main Results:

  • No apparent bleeding upon presentation.
  • TEG® 6s values normalized approximately 20 hours post-ingestion.
  • Patient discharged without complications or bleeding.

Conclusions:

  • TEG® 6s may be a valuable tool for monitoring rivaroxaban's effects in pediatric overdose.
  • Accidental large-dose rivaroxaban ingestion in children can be managed with close observation.
  • Normalization of coagulation parameters suggests recovery from anticoagulant effects.

Keywords:
Factor Xa inhibitorsHome accidentsNovel oral anticoagulantsOverdoseTEG® 6s

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