Massive Intoxication with 70 Tablets of Apixaban: A Case Report
Apixaban is a direct oral anticoagulation agent that exerts its effect through the direct inhibition of factor Xa. We treated a case of massive intoxication with 70 tablets of apixaban and have presented the clinical course of the associated anti-Xa activities. A 49-year-old woman was admitted to th...
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| Format: | Article |
| Language: | English |
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Karger Publishers
2023-09-01
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| Series: | Case Reports in Acute Medicine |
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| Online Access: | https://beta.karger.com/Article/FullText/533520 |
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| author | Tadahiro Kobayashi Satoko Saito Masayuki Takada Kento Sakaguchi Kazunori Takahashi Ken Tanaka Kaneyuki Kawamae Masaki Nakane |
| author_facet | Tadahiro Kobayashi Satoko Saito Masayuki Takada Kento Sakaguchi Kazunori Takahashi Ken Tanaka Kaneyuki Kawamae Masaki Nakane |
| author_sort | Tadahiro Kobayashi |
| collection | DOAJ |
| description | Apixaban is a direct oral anticoagulation agent that exerts its effect through the direct inhibition of factor Xa. We treated a case of massive intoxication with 70 tablets of apixaban and have presented the clinical course of the associated anti-Xa activities. A 49-year-old woman was admitted to the emergency department approximately 1.5 h after impulsive self-intoxication with 175 mg of apixaban. She developed coagulopathy with prothrombin time-international normalized ratio (PT-INR) of 3.65, activated partial thromboplastin time of 56.5 s, and antithrombin activity (AT) of >150% (at 1.5 h post-ingestion). The patient’s initial and peak anti-Xa activity was 17.7 IU/mL, and its elimination displayed first-order kinetics with a half-life of 10.5 h. The patient’s anti-Xa activity was within the therapeutic dose range at 26 h post-ingestion, and she recovered without experiencing any bleeding complications. Her coagulopathy also returned to normal level at the same timing. This result suggests that PT-INR and AT can be used as substitute markers of overwhelmed anticoagulation following massive overdose of apixaban. A case of apixaban overdose with associated anti-Xa activities was presented. There was favorable resolution of anticoagulation without specific treatments. |
| first_indexed | 2024-03-11T19:33:48Z |
| format | Article |
| id | doaj.art-7ea2916d40274f09acb2fec3e0498772 |
| institution | Directory Open Access Journal |
| issn | 2504-5288 |
| language | English |
| last_indexed | 2024-03-11T19:33:48Z |
| publishDate | 2023-09-01 |
| publisher | Karger Publishers |
| record_format | Article |
| series | Case Reports in Acute Medicine |
| spelling | doaj.art-7ea2916d40274f09acb2fec3e04987722023-10-06T13:15:02ZengKarger PublishersCase Reports in Acute Medicine2504-52882023-09-0161131810.1159/000533520533520Massive Intoxication with 70 Tablets of Apixaban: A Case ReportTadahiro Kobayashi0Satoko Saito1Masayuki Takada2Kento Sakaguchi3Kazunori Takahashi4Ken Tanaka5Kaneyuki Kawamae6Masaki Nakane7Department of Emergency and Critical Care Medicine, Yamagata University Faculty of Medicine, Yamagata, JapanDepartment of Emergency and Critical Care Medicine, Yamagata University Faculty of Medicine, Yamagata, JapanDepartment of Emergency and Critical Care Medicine, Yamagata University Faculty of Medicine, Yamagata, JapanDepartment of Emergency and Critical Care Medicine, Yamagata University Faculty of Medicine, Yamagata, JapanDepartment of Emergency and Critical Care Medicine, Yamagata University Faculty of Medicine, Yamagata, JapanDepartment of Emergency and Critical Care Medicine, Yamagata University Faculty of Medicine, Yamagata, JapanDepartment of Emergency and Critical Care Medicine, Yamagata University Faculty of Medicine, Yamagata, JapanDepartment of Emergency and Critical Care Medicine, Yamagata University Faculty of Medicine, Yamagata, JapanApixaban is a direct oral anticoagulation agent that exerts its effect through the direct inhibition of factor Xa. We treated a case of massive intoxication with 70 tablets of apixaban and have presented the clinical course of the associated anti-Xa activities. A 49-year-old woman was admitted to the emergency department approximately 1.5 h after impulsive self-intoxication with 175 mg of apixaban. She developed coagulopathy with prothrombin time-international normalized ratio (PT-INR) of 3.65, activated partial thromboplastin time of 56.5 s, and antithrombin activity (AT) of >150% (at 1.5 h post-ingestion). The patient’s initial and peak anti-Xa activity was 17.7 IU/mL, and its elimination displayed first-order kinetics with a half-life of 10.5 h. The patient’s anti-Xa activity was within the therapeutic dose range at 26 h post-ingestion, and she recovered without experiencing any bleeding complications. Her coagulopathy also returned to normal level at the same timing. This result suggests that PT-INR and AT can be used as substitute markers of overwhelmed anticoagulation following massive overdose of apixaban. A case of apixaban overdose with associated anti-Xa activities was presented. There was favorable resolution of anticoagulation without specific treatments.https://beta.karger.com/Article/FullText/533520antithrombin activityanti-xa activityapixabanintoxicationprothrombin time-international normalized ratio |
| spellingShingle | Tadahiro Kobayashi Satoko Saito Masayuki Takada Kento Sakaguchi Kazunori Takahashi Ken Tanaka Kaneyuki Kawamae Masaki Nakane Massive Intoxication with 70 Tablets of Apixaban: A Case Report Case Reports in Acute Medicine antithrombin activity anti-xa activity apixaban intoxication prothrombin time-international normalized ratio |
| title | Massive Intoxication with 70 Tablets of Apixaban: A Case Report |
| title_full | Massive Intoxication with 70 Tablets of Apixaban: A Case Report |
| title_fullStr | Massive Intoxication with 70 Tablets of Apixaban: A Case Report |
| title_full_unstemmed | Massive Intoxication with 70 Tablets of Apixaban: A Case Report |
| title_short | Massive Intoxication with 70 Tablets of Apixaban: A Case Report |
| title_sort | massive intoxication with 70 tablets of apixaban a case report |
| topic | antithrombin activity anti-xa activity apixaban intoxication prothrombin time-international normalized ratio |
| url | https://beta.karger.com/Article/FullText/533520 |
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