{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,30]],"date-time":"2026-07-30T00:59:53Z","timestamp":1785373193992,"version":"3.55.0"},"reference-count":17,"publisher":"Wiley","issue":"8","license":[{"start":{"date-parts":[[2026,4,24]],"date-time":"2026-04-24T00:00:00Z","timestamp":1776988800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2026,4,24]],"date-time":"2026-04-24T00:00:00Z","timestamp":1776988800000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"funder":[{"DOI":"10.13039\/501100000925","name":"National Health and Medical Research Council","doi-asserted-by":"publisher","award":["ID 2016380"],"award-info":[{"award-number":["ID 2016380"]}],"id":[{"id":"10.13039\/501100000925","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Br J Clin Pharmacol"],"published-print":{"date-parts":[[2026,8]]},"abstract":"<jats:sec>\n                    <jats:title>Aim<\/jats:title>\n                    <jats:p>There is limited research describing rivaroxaban overdose. We aim to describe rivaroxaban overdose, coagulopathy and bleeding complications.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>This is a prospective series of acute adult (&gt;14 years) rivaroxaban overdose presentations &gt;40\u2009mg 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.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      There were 58 presentations in 52 patients, 29\/52 (56%) males, median age of 49 years (range: 18\u201393 years). The median reported dose ingested was 200\u2009mg (IQR: 92.5\u2013400\u2009mg, range: 45\u20131120\u2009mg). Co\u2010ingestants were taken in 49 (84%), most commonly mirtazapine and paracetamol. A raised international normalized ratio (INR) of &gt;1.5 occurred in 46 (79%) with a median peak INR of 2.5 (IQR: 1.7\u20133.7). The median duration for an elevated INR to return to \u22641.5 was 22\u2009h (IQR: 14\u201338\u2009h). 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 (\n                      <jats:italic>R<\/jats:italic>\n                      <jats:sup>2<\/jats:sup>\n                      \u00a0=\u00a00.83,\n                      <jats:italic>p<\/jats:italic>\n                      \u00a0&lt;\u2009.001) between rivaroxaban concentration and INR. An INR of \u22641.5 was associated with therapeutic rivaroxaban concentrations. There was one death attributed to co\u2010ingested amlodipine.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Bleeding was uncommon following rivaroxaban overdose. The INR appears to be a good indicator of coagulopathy, with an INR of \u22641.5 approximating therapeutic rivaroxaban concentrations. Observation of patients following acute rivaroxaban overdose until the INR\u2009\u2264\u00a01.5 seems reasonable.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1002\/bcp.70588","type":"journal-article","created":{"date-parts":[[2026,4,25]],"date-time":"2026-04-25T01:49:45Z","timestamp":1777081785000},"page":"2828-2833","source":"Crossref","is-referenced-by-count":0,"title":["A prospective series of acute rivaroxaban overdose, coagulopathy and bleeding complications (ATOM 11)"],"prefix":"10.1002","volume":"92","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-1176-7923","authenticated-orcid":false,"given":"Katherine Z.","family":"Isoardi","sequence":"first","affiliation":[{"name":"Clinical Toxicology Unit Princess Alexandra Hospital  Brisbane Australia"},{"name":"Queensland Poisons Information Centre Queensland Children's Hospital  Brisbane Australia"},{"name":"Faculty of Medicine University of Queensland  Brisbane Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0079-5056","authenticated-orcid":false,"given":"Angela L.","family":"Chiew","sequence":"additional","affiliation":[{"name":"Clinical Toxicology Unit Prince of Wales Hospital  Sydney Australia"},{"name":"New South Wales Poisons Information Centre Children's Hospital at Westmead  Westmead Australia"},{"name":"School of Medicine University of New South Wales  Sydney Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0724-1088","authenticated-orcid":false,"given":"Keith","family":"Harris","sequence":"additional","affiliation":[{"name":"Clinical Toxicology Unit Princess Alexandra Hospital  Brisbane Australia"},{"name":"Queensland Poisons Information Centre Queensland Children's Hospital  Brisbane Australia"},{"name":"Faculty of Medicine University of Queensland  Brisbane Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1519-7419","authenticated-orcid":false,"given":"Geoffrey K.","family":"Isbister","sequence":"additional","affiliation":[{"name":"Department of Clinical Toxicology Calvary Mater Newcastle Hospital  Newcastle Australia"},{"name":"Clinical Toxicology Research Group University of Newcastle  Newcastle 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