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In cases of overdose, the risk of prolonged, life\u2010threatening hemorrhage increases substantially, necessitating targeted interventions, such as pharmacological reversal agents. Rapid identification of elevated anticoagulant levels is crucial to initiate specific countermeasures and limit blood loss, and point\u2010of\u2010care testing may facilitate timely treatment. In our case of an extreme overdose of apixaban (max 5664.24\u2009ng\/mL, first report of such high amount) has resulted in serious and life\u2010threatening clinical symptoms due to sustained multiple injuries. It is still a debate which therapies prove the most efficacious, whereby the vast surplus of apixaban and the short half\u2010life of andexanet alfa must be considered. This case, in which high apixaban concentration persisted, might help to shed light on these issues.<\/jats:p>","DOI":"10.1002\/prp2.70228","type":"journal-article","created":{"date-parts":[[2026,3,21]],"date-time":"2026-03-21T04:16:47Z","timestamp":1774066607000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Excessive Apixaban Concentrations in a Bleeding Patient Treated With Pharmacological Reversal and Extracorporal Removal\u2014A Case Report"],"prefix":"10.1002","volume":"14","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-5280-6530","authenticated-orcid":false,"given":"Richard Felix","family":"Kraus","sequence":"first","affiliation":[{"name":"Department of Anaesthesiology and Intensive Care Medicine University Hospital Regensburg  Regensburg Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Johanna","family":"Rosenberger","sequence":"additional","affiliation":[{"name":"Department of 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