Year: 2026
Type: article
Study design: Case Report
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.
Source: Journal of Medical Toxicology
Authors: Rebecca Kusko, Jami Hagemann, Daniel McCabe, Joshua Trebach
Institution: University of Iowa
Language: English
Subfield: Emergency Medicine
Field: Medicine
Domain: Health Sciences
Open Access status: hybrid
Estimated APC paid: $4,990
OpenAlex ID: W7153991082