title: Massive intoxication with rivaroxaban, phenprocoumon, and diclofenac: A case report.
abstract: BACKGROUND
  Oral anticoagulants and painkillers, some with an additional effect on the coagulation system, are widely used and are therefore prone to abuse and (intentional) overdose. We report the case of a patient with a massive mixed anticoagulant intoxication.
  
  
  METHODS
  The patient had ingested 1960 mg rivaroxaban, 31.5 mg phenprocoumon, 1425 mg diclofenac, and 21,000 mg metamizole in suicidal intention.
  
  
  METHODS
  Massive mixed anticoagulant overdose.
  
  
  METHODS
  The patient was closely monitored. The phenprocoumon overdose was treated by the administration of vitamin K and PCC.
  
  
  RESULTS
  Despite the massive inhibition of the coagulation system, the patient did not experience bleeding apart from a slight gross hematuria.
  
  
  CONCLUSIONS
  Despite the ingestion of a massive amount of rivaroxaban, the plasma levels were not as high as feared, due to the ceiling effect of rivaroxaban absorption. Elimination occurred according to the half-life of rivaroxaban and was not unduly prolonged by the ingested quantity.
authors.affiliation: Transfusion Medicine and Hemostaseology Department Department of Internal Medicine 4 Department of Forensic Medicine, University Hospital Erlangen, Erlangen, Germany.
authors.forename: Hella
authors.initials: H
authors.lastname: Pfeiffer
authors.forename: Larissa
authors.initials: L
authors.lastname: Herbst
authors.forename: Bernd
authors.initials: B
authors.lastname: Schwarze
authors.forename: Reinhold
authors.initials: R
authors.lastname: Eckstein
authors.forename: Volker
authors.initials: V
authors.lastname: Weisbach
mesh_terms: D000925:Anticoagulants / Q000506:poisoning*; D016861:Cyclooxygenase Inhibitors / Q000506:poisoning*; D004008:Diclofenac / Q000506:poisoning*; D065427:Factor Xa Inhibitors / Q000506:poisoning*; D006801:Humans; D008297:Male; D010644:Phenprocoumon / Q000506:poisoning*; D000069552:Rivaroxaban / Q000506:poisoning*; D055815:Young Adult
chemical_list: D000925:Anticoagulants; D016861:Cyclooxygenase Inhibitors; D065427:Factor Xa Inhibitors; D004008:Diclofenac; D000069552:Rivaroxaban; D010644:Phenprocoumon