Steps to diagnosis of a case of surreptitious intake of one of the newer direct oral anticoagulants

Abstract

Little is known about the effects of newer oral anticoagulants on various coagulation factors. When presented with a case of intentional or suspected overdose with an abnormal coagulation profile, it is imperative to have a working diagnostic algorithm to narrow the cause to a specific drug or drug class. This may become more crucial and time sensitive when dealing with a case of acute hemorrhage. Here we discuss the first reported case of what appears to be a surreptitious intake of newer oral anticoagulants and the steps leading to the diagnosis.

Conservative management of massive rivaroxaban overdose: A case report and literature review

“…We conducted a literature search to identify similar cases, and the characteristics of the patients, along with the treatment, are shown in Table 1 . 7 , 8 , 9 , 10 , 11 , 12 , 13 , 14 , 15 , 16 , 17 , 18 …”

“…Here, we reported a case of rivaroxaban overdose that had a favorable outcome with conservative management and did not require the administration of any fresh frozen plasma, blood products, or prothrombin complex concentrate (PCC). We conducted a literature search to identify similar cases, and the characteristics of the patients, along with the treatment, are shown in Table 1 7‐18 …”

Massive intoxication with rivaroxaban, phenprocoumon, and diclofenac

“…[ 1 ] Additionally, 1 case of surreptitious rivaroxaban intake was found. [ 4 ] We present, to our knowledge, the first case with a massive combination overdose of rivaroxaban, phenprocoumon, and diclofenac, and also metamizole, resulting in a massive inhibition of the secondary, and also the primary coagulation system. Despite this, the patient never showed signs of significant bleeding, thereby underlining the importance of stable blood vessels.…”

“…[ 1 – 3 ] In the case of surreptitious rivaroxaban intake, the patient presented with menorrhagia, epistaxis, and easy bruising, but no serious bleeding was observed and no treatment was necessary. [ 4 ] All 4 case reports postulated that a pre-emptive administration of coagulation factors might not be necessary, but dependent on clinical findings, and likely did not improve the clinical outcome. [ 1 – 4 ]…”

“…[ 4 ] All 4 case reports postulated that a pre-emptive administration of coagulation factors might not be necessary, but dependent on clinical findings, and likely did not improve the clinical outcome. [ 1 – 4 ]…”