ArticleBritish journal of clinical pharmacology2026
A prospective series of acute rivaroxaban overdose, coagulopathy and bleeding complications (ATOM 11).
Article in British journal of clinical pharmacology, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 1 paper.
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Who cites it
1 citing paper in PubMed.
- A prospective series of acute rivaroxaban overdose, coagulopathy and bleeding complications (ATOM 11).British journal of clinical pharmacology · 2026Article
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Authors and funding
4 authors.
Funding
Abstract
aimThere is limited research describing rivaroxaban overdose. We aim to describe rivaroxaban overdose, coagulopathy and bleeding complications.
methodsThis is a prospective series of acute adult (>14 years) rivaroxaban overdose presentations >40 mg enrolled in the Australian Toxicology Monitoring study and presenting to three Australian clinical toxicology units from August 2014 to August 2024. Data collected included demographics, ingestion details, coagulation profile, rivaroxaban concentrations, significant bleeding (with haemoglobin decrement) and outcome.
resultsThere were 58 presentations in 52 patients, 29/52 (56%) males, median age of 49 years (range: 18-93 years). The median reported dose ingested was 200 mg (IQR: 92.5-400 mg, range: 45-1120 mg). Co-ingestants were taken in 49 (84%), most commonly mirtazapine and paracetamol. A raised international normalized ratio (INR) of >1.5 occurred in 46 (79%) with a median peak INR of 2.5 (IQR: 1.7-3.7). The median duration for an elevated INR to return to ≤1.5 was 22 h (IQR: 14-38 h). Significant bleeding occurred in two patients; both were managed conservatively without factor replacement. Rivaroxaban concentrations were available in 11 cases. There was a strong correlation (R
conclusionBleeding was uncommon following rivaroxaban overdose. The INR appears to be a good indicator of coagulopathy, with an INR of ≤1.5 approximating therapeutic rivaroxaban concentrations. Observation of patients following acute rivaroxaban overdose until the INR ≤ 1.5 seems reasonable.
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