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Apixaban Overdose with Massive Bleeding and Anti-Xa Levels
Journal article   Open access   Peer reviewed

Apixaban Overdose with Massive Bleeding and Anti-Xa Levels

Rebecca Kusko, Jami Hagemann, Daniel McCabe and Joshua Trebach
Journal of medical toxicology
04/13/2026
DOI: 10.1007/s13181-026-01137-5
PMID: 41975035
Appears in  UI Libraries Support Open Access
url
https://doi.org/10.1007/s13181-026-01137-5View
Published (Version of record) Open Access

Abstract

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. 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. 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.
 Direct Oral Anticoagulant Overdose Hemorrhage Apixaban Case Report UIOWA OA Agreement

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