title: Lack of significant bleeding despite large acute rivaroxaban overdose confirmed with whole blood concentrations.
abstract: BACKGROUND
  Since intentional overdose with rivaroxaban is expected to lead to significant coagulopathy and bleeding, prophylactic reversal has been suggested. We report a single massive ingestion confirmed by a blood concentration that was managed with expectant therapy alone.
  
  
  METHODS
  A 71-year-old man with atrial fibrillation, aortic valve replacement, and congestive heart failure presented to the emergency department after an intentional ingestion of 97 (1940 mg total) rivaroxaban tablets in a suicide attempt. Initial laboratories revealed: PT, 60.2 s; INR 7.2; aPTT, 55.7 s; BUN 28 mg/dL; and creatinine 1.2 mg/dL. A whole-blood rivaroxaban concentration obtained on hospital-day three was 160 ng/mL. The patient was admitted for continued observation and the coagulation markers trended downward with no major bleeding events. No reversal agents or blood products were given during his hospitalization.
  
  
  CONCLUSIONS
  In the setting of a single, acute rivaroxaban overdose, with normal renal function, and no active bleeding, conservative therapy alone may be sufficient.
authors.affiliation: a Division of Medical Toxicology, Ronald O. Perelman Department of Emergency Medicine , New York University School of Medicine , New York , NY , USA ;|b New York City Poison Control Center , New York , NY , USA ;
authors.forename: Daniel J
authors.initials: DJ
authors.lastname: Repplinger
authors.affiliation: a Division of Medical Toxicology, Ronald O. Perelman Department of Emergency Medicine , New York University School of Medicine , New York , NY , USA ;|b New York City Poison Control Center , New York , NY , USA ;
authors.forename: Robert S
authors.initials: RS
authors.lastname: Hoffman
authors.affiliation: a Division of Medical Toxicology, Ronald O. Perelman Department of Emergency Medicine , New York University School of Medicine , New York , NY , USA ;|b New York City Poison Control Center , New York , NY , USA ;
authors.forename: Lewis S
authors.initials: LS
authors.lastname: Nelson
authors.affiliation: a Division of Medical Toxicology, Ronald O. Perelman Department of Emergency Medicine , New York University School of Medicine , New York , NY , USA ;|b New York City Poison Control Center , New York , NY , USA ;
authors.forename: Elizabeth Q
authors.initials: EQ
authors.lastname: Hines
authors.affiliation: a Division of Medical Toxicology, Ronald O. Perelman Department of Emergency Medicine , New York University School of Medicine , New York , NY , USA ;|b New York City Poison Control Center , New York , NY , USA ;|c Health Sciences , St. John's University College of Pharmacy , Jamaica , NY , USA.
authors.forename: MaryAnn
authors.initials: M
authors.lastname: Howland
authors.affiliation: a Division of Medical Toxicology, Ronald O. Perelman Department of Emergency Medicine , New York University School of Medicine , New York , NY , USA ;|b New York City Poison Control Center , New York , NY , USA ;
authors.forename: Mark K
authors.initials: MK
authors.lastname: Su
mesh_terms: D000368:Aged; D001779:Blood Coagulation Factors / Q000032:analysis; D062787:Drug Overdose; D065427:Factor Xa Inhibitors / Q000008:administration & dosage / Q000097:blood / Q000506:poisoning*; D006470:Hemorrhage / Q000097:blood / Q000175:diagnosis* / Q000628:therapy; D006801:Humans; D008297:Male; D000069552:Rivaroxaban / Q000008:administration & dosage / Q000097:blood / Q000506:poisoning*; D013406:Suicide, Attempted; D016896:Treatment Outcome
chemical_list: D001779:Blood Coagulation Factors; D065427:Factor Xa Inhibitors; D000069552:Rivaroxaban
keywords: Rivaroxaban; anticoagulant; overdose; toxicity