Rebecca Kusko, Jami Hagemann, Daniel McCabe, Joshua Trebach
{"title":"Apixaban Overdose with Massive Bleeding and Anti-Xa Levels.","authors":"Rebecca Kusko, Jami Hagemann, Daniel McCabe, Joshua Trebach","doi":"10.1007/s13181-026-01137-5","DOIUrl":null,"url":null,"abstract":"<p><strong>Introduction: </strong>While use of factor Xa inhibitors has increased, there are relatively few cases of overdose reported. Clinically relevant bleeding is often absent, and the behavior of drug levels in overdose is not fully agreed on.</p><p><strong>Case report: </strong>A 70-year-old male presented after a polysubstance overdose including at least 250 mg of apixaban with massive gastrointestinal (GI) hemorrhage and parafalcine and tentorial subdural hematoma. He was treated with 1 gram tranexamic acid (TXA), anti-inhibitor coagulant complex (FEIBA), and massive transfusion. No further episodes of bleeding were observed. Anti-Xa levels were trended until undetectable.</p><p><strong>Discussion: </strong>Bleeding from an overdose of factor Xa inhibitors is a relatively rare occurrence; however, this case illustrates that life threatening hemorrhage can occur and may require aggressive supportive care. Anti-Xa levels demonstrated a first order pattern of elimination even at markedly supratherapeutic concentrations, consistent with several prior case reports.</p>","PeriodicalId":16429,"journal":{"name":"Journal of Medical Toxicology","volume":" ","pages":""},"PeriodicalIF":2.6000,"publicationDate":"2026-04-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Journal of Medical Toxicology","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1007/s13181-026-01137-5","RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q3","JCRName":"TOXICOLOGY","Score":null,"Total":0}
引用次数: 0
Abstract
Introduction: While use of factor Xa inhibitors has increased, there are relatively few cases of overdose reported. Clinically relevant bleeding is often absent, and the behavior of drug levels in overdose is not fully agreed on.
Case report: A 70-year-old male presented after a polysubstance overdose including at least 250 mg of apixaban with massive gastrointestinal (GI) hemorrhage and parafalcine and tentorial subdural hematoma. He was treated with 1 gram tranexamic acid (TXA), anti-inhibitor coagulant complex (FEIBA), and massive transfusion. No further episodes of bleeding were observed. Anti-Xa levels were trended until undetectable.
Discussion: Bleeding from an overdose of factor Xa inhibitors is a relatively rare occurrence; however, this case illustrates that life threatening hemorrhage can occur and may require aggressive supportive care. Anti-Xa levels demonstrated a first order pattern of elimination even at markedly supratherapeutic concentrations, consistent with several prior case reports.
期刊介绍：
Journal of Medical Toxicology (JMT) is a peer-reviewed medical journal dedicated to advances in clinical toxicology, focusing on the diagnosis, management, and prevention of poisoning and other adverse health effects resulting from medications, chemicals, occupational and environmental substances, and biological hazards. As the official journal of the American College of Medical Toxicology (ACMT), JMT is managed by an editorial board of clinicians as well as scientists and thus publishes research that is relevant to medical toxicologists, emergency physicians, critical care specialists, pediatricians, pre-hospital providers, occupational physicians, substance abuse experts, veterinary toxicologists, and policy makers. JMT articles generate considerable interest in the lay media, with 2016 JMT articles cited by various social media sites, the Boston Globe, and the Washington Post among others. For questions or comments about the journal, please contact jmtinfo@acmt.net.
For questions or comments about the journal, please contact jmtinfo@acmt.net.
求助内容：
应助结果提醒方式：
京公网安备 11010802042870号
