Enhanced elimination

Apixaban and rivaroxaban are extensively bound to plasma protein, so haemodialysis cannot significantly increase clearance and is not recommended.

Both apixaban and rivaroxaban exhibit enteroenteric recirculation, therefore multiple-dose activated charcoal may increase clearanceWang 2014Ollier 2017. Consider the use of multiple-dose activated charcoal in patients likely to have prolonged elimination (eg large ingestions, severe kidney impairment) or for life-threatening poisonings.

If considering the use of multiple-dose activated charcoal, seek advice from a clinical toxicologist.