Observation and patient disposition after apixaban and rivaroxaban poisonings

Admit all patients following deliberate ingestions of apixaban or rivaroxaban. Patients may be discharged if coagulation assays have normalised to the individual’s baseline, the anti-Xa assay result (if available) is in a normal range or falling (demonstrated on blood tests done on admission and at 6 hours after ingestion), and there is no evidence of bleeding.

Discharge adult patients who have inadvertently taken a double dose of apixaban or rivaroxaban if they have normal kidney function, a low risk of falls, and no significant risk factors for haemorrhage (eg recent surgery, trauma or gastrointestinal bleed).

Accidental ingestion of apixaban or rivaroxaban by a child is unlikely to cause bleeding. These patients can be discharged with responsible adult supervision. Advise patients to avoid activities that risk physical injury (eg bike riding, tree climbing) for at least 24 hours.