Management overview for apixaban and rivaroxaban poisonings

Apixaban and rivaroxaban are oral anticoagulants that exert their effect via direct inhibition of factor Xa. Along with the direct thrombin inhibitor, dabigatran, they are sometimes referred to collectively as non–vitamin K antagonist oral anticoagulants (NOACs) or direct oral anticoagulants (DOACs).

Deliberate poisoning with apixaban or rivaroxaban is currently uncommon. This monograph covers poisoning due to deliberate or accidental ingestion of apixaban or rivaroxaban. For management of bleeding and overanticoagulation in patients taking apixaban or rivaroxaban therapeutically, see Bleeding and overanticoagulation with apixaban and Bleeding and overanticoagulation with rivaroxaban in the Cardiovascular guidelines.

Following apixaban or rivaroxaban poisoning, the risk of spontaneous haemorrhage is low. The risk of spontaneous haemorrhage is higher if the patient has a potential source of bleeding (eg a wound or injury) or other patient-associated risk factor for bleeding, particularly concurrent use of an antiplatelet drug (see Patient-associated factors that increase bleeding risk with anticoagulant therapy for patient-associated factors that increase bleeding risk with anticoagulant therapy).

Management of apixaban or rivaroxaban poisoning is supportive care, unless there is associated haemorrhage. Supportive care should focus on removing or minimising secondary risk factors for haemorrhage. This includes falls prevention, wound care and management of hypertension.