title: Anti-Xa activity in apixaban overdose: a case report.
abstract: BACKGROUND
  Apixaban is a novel oral anticoagulation agent that exerts its effect through direct factor Xa inhibition. We present a case of multi-drug overdose including apixaban with associated apixaban concentrations.
  
  
  METHODS
  A 53 year-old man presented to our metropolitan hospital following a deliberate self-poisoning with 200 mg apixaban, 35 mg ramipril, 105 mg bisoprolol, 280 mg atorvastatin, 6 mg colchicine, 37.4 mg magnesium, 4 × 500 mg paracetamol/9.5 mg codeine/5 mg phenylephrine and alcohol. He developed hypotension that was treated with noradrenaline. His initial and peak apixaban concentration was 1022.6 ng/ml and was associated with only minor bleeding from his femoral central line insertion site, which improved with local compression. Vitamin K 10 mg (at 9 h post-ingestion) and Prothrombinex-VF 2000 units (at 13 h post-ingestion) were also administered without any observed effect on coagulation studies. Apixaban elimination appeared to display first-order kinetics with an elimination half-life of 7.4 h. His plasma apixaban concentration was within the therapeutic dose range 10 h post-ingestion and he recovered uneventfully.
  
  
  CONCLUSIONS
  A case of apixaban overdose with associated apixaban concentrations is presented. There was rapid resolution of anticoagulation with no demonstrable benefit of currently available clotting factor replacement.
authors.affiliation: a Monash Clinical Toxicology, Program of Emergency Medicine , Monash Health , Victoria , Australia.
authors.forename: James
authors.initials: J
authors.lastname: Barton
authors.affiliation: a Monash Clinical Toxicology, Program of Emergency Medicine , Monash Health , Victoria , Australia.|b School of Clinical Sciences at Monash Health, Faculty of Medicine, Nursing and Health Sciences , Monash University , Victoria , Australia.
authors.forename: Anselm
authors.initials: A
authors.lastname: Wong
authors.affiliation: a Monash Clinical Toxicology, Program of Emergency Medicine , Monash Health , Victoria , Australia.|b School of Clinical Sciences at Monash Health, Faculty of Medicine, Nursing and Health Sciences , Monash University , Victoria , Australia.
authors.forename: Andis
authors.initials: A
authors.lastname: Graudins
mesh_terms: D000284:Administration, Oral; D000933:Antifibrinolytic Agents / Q000008:administration & dosage; D001779:Blood Coagulation Factors / Q000008:administration & dosage; D062787:Drug Overdose; D015951:Factor Xa / Q000187:drug effects* / Q000378:metabolism; D065427:Factor Xa Inhibitors / Q000008:administration & dosage / Q000493:pharmacokinetics / Q000506:poisoning*; D006207:Half-Life; D006801:Humans; D008297:Male; D008875:Middle Aged; D011720:Pyrazoles / Q000008:administration & dosage / Q000493:pharmacokinetics / Q000506:poisoning*; D011728:Pyridones / Q000008:administration & dosage / Q000493:pharmacokinetics / Q000506:poisoning*; D014812:Vitamin K / Q000008:administration & dosage*
chemical_list: D000933:Antifibrinolytic Agents; D001779:Blood Coagulation Factors; D065427:Factor Xa Inhibitors; D011720:Pyrazoles; D011728:Pyridones; D014812:Vitamin K; C025667:prothrombin complex concentrates; C522181:apixaban; D015951:Factor Xa
keywords: Factor Xa inhibitors; oral anticoagulants; toxicokinetics