Circulation
Cardiovascular complications are uncommon after apixaban or rivaroxaban poisoning, unless haemorrhage occurs. If hypotension is problematic, start intravenous fluid resuscitation. Intravenous fluid therapy is also important to optimise renal excretion of the anticoagulant drug.
Management of acute haemorrhage includes:
- local haemostatic measures (eg mechanical compression) for accessible sources of bleeding
- surgical or interventional radiological treatment (eg embolisation) for noncompressible bleeding
- blood transfusion based on the patient’s haemodynamics and serial haemoglobin concentrations
- platelet transfusion to reduce haemorrhage risk in patients with a platelet count less than 50 x 109/L or on antiplatelet therapy.
A prohaemostatic agent may be indicated for life-threatening bleeding or bleeding into a critical organ or space (eg intracranial, intraspinal, intraocular, pericardial or retroperitoneal spaces; bleeding causing compartment syndrome). There is limited evidence for prohaemostatic agents to control bleeding related to apixaban or rivaroxaban, and there is a risk of thrombotic complications. Seek expert advice before use.
For adults and children, use:
Prothrombinex-VF 50 units/kg intravenously by slow injection1. apixaban and rivaroxiban poisonings
Alternatively or in addition to Prothrombinex-VF, in adults, use:
tranexamic acid 1 g intravenously at a rate not exceeding 100 mg/minute apixaban and rivaroxiban poisonings
FOLLOWED BY
tranexamic acid 1 g intravenously, over 8 hours.
Seek expert advice for dosing of tranexamic acid in children, and if there is ongoing bleeding or abnormal coagulation assays.
There is no evidence to support the use of recombinant factor VIIa.