Massive intoxication with rivaroxaban, phenprocoumon, and diclofenac: A case report. Issue 44 (November 2016)

• Record Type: Journal Article
• Authors: Pfeiffer, Hella; Herbst, Larissa; Schwarze, Bernd; Eckstein, Reinhold; Weisbach, Volker
• Other Names: Zhou. Wen section editor.
• Is Part Of: Medicine. Volume 95:Issue 44(2016)
• Publication Date: 2016-11
• Subjects: anticoagulant intoxication -- case report -- overdose -- phenprocoumon -- rivaroxaban; Medicine -- Periodicals; Medicine -- Periodicals; Médecine -- Périodiques; Geneeskunde; Medicine; Periodicals; Periodicals; 610.5
• DOI: 10.1097/MD.0000000000005343
• Languages: English
• ISSNs: 0025-7974

Abstract

Abstract: Rationale: 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. Patient concerns: The patient had ingested 1960 mg rivaroxaban, 31.5 mg phenprocoumon, 1425 mg diclofenac, and 21, 000 mg metamizole in suicidal intention. Diagnoses: Massive mixed anticoagulant overdose. Interventions: The patient was closely monitored. The phenprocoumon overdose was treated by the administration of vitamin K and PCC. Outcomes: Despite the massive inhibition of the coagulation system, the patient did not experience bleeding apart from a slight gross hematuria. Lessons: 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.