PB0462 - Watchfull waiting: A conservative management of rivaroxaban overdose

Sunday, July 10, 2022

6:30 PM – 7:30 PM

Location: Exhibition

Presentation Format: In-Person

Co-Author(s)

Ines Machado, MSc

MD, Immunohemotherapy Department
Centro Hospitalar Universitário de São João
Porto, Porto, Portugal

Presenting Author(s)

Sofia Teixeira, MA

MD, Immunohemotherapy Department
Centro Hospitalar Universitário de São João
Porto, Porto, Portugal

Co-Author(s)

LG

Luciana Gonçalves

MD
Immunohemotherapy Department, Centro Hospitalar Universitário de São João
Porto, Porto, Portugal
Diana Cibele, MD

Immunohemotherapy Department, Centro Hospitalar Universitário de São João
Centro Hospitalar Universitário São João
Porto, Porto, Portugal
MC

Manuela Carvalho

MD
Immunohemotherapy Department, Centro Hospitalar Universitário de São João
Porto, Porto, Portugal
CN

Cristina Neves

Attending
Center of Thombosis and Haemostasis, Department of Immunohemotherapy, Centro Hospitalar e Universitário São João
Porto, Porto, Portugal
CK

Carmo Koch

MD
Immunohemotherapy Department, Centro Hospitalar Universitário de São João, Porto, Portugal
Porto, Porto, Portugal

Background: Rivaroxaban is an active direct factor Xa inhibitor mainly used to treat venous thromboembolism, as well as for the prevention of embolic stroke in atrial fibrillation, with a standard dose of 20 mg once daily. According to literature, the maximum factor Xa inhibition by rivaroxaban occurs after 2-4 hours and the terminal half-life is 8–12 hours.

Aims: The aim of this study was to review a clinical case with an overdose of rivaroxaban.

Methods: A 78-year-old female patient presented to the hospital 3 hours after a deliberate self-intoxication with 1400 mg of rivaroxaban (70 tablets of 20 mg).
At the admission time, she was conscious (Glasgow Coma Scale 15/15), with no alterations in vital signs or any symptoms or signs of hemorrhage.

Results: In Portugal, where there are no established pharmacological tools to fully reverse the anticoagulant effect of rivaroxaban, prothrombin complex concentrate (PPC) can be used to improve hemostasis.
The first approach was to give 50 g of oral activated charcoal, diuresis stimulation and close monitoring of arterial blood pressure in bed rest. At the same time, rivaroxaban concentrations, Prothrombin Time and Activated Partial Thromboplastin Time were monitored (Figures 1 and 2). Initial hemogram and biochemistry parameters were normal, in particular, normal renal function.
The overdose was asymptomatic in a patient with low risk of bleeding. The rivaroxaban concentration in plasma was in the trough level 18 h post-ingestion and the patient recovered uneventfully. She was discharged to the psychiatric ward on day 3.

Conclusion(s): We report a case of rivaroxaban overdose with favorable outcome with conservative management – it did not require administration of PPC, fresh frozen plasma or any blood products. A close clinical surveillance and specific assays to monitoring rivaroxaban concentrations can help the management of this unusual situations.