{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,18]],"date-time":"2026-09-18T10:13:38Z","timestamp":1789726418224,"version":"4.0.1"},"reference-count":17,"publisher":"SAGE Publications","issue":"3","license":[{"start":{"date-parts":[[2023,5,25]],"date-time":"2023-05-25T00:00:00Z","timestamp":1684972800000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["Journal of Pharmacy Practice"],"published-print":{"date-parts":[[2024,6]]},"abstract":"<jats:p>\n                    Background: Acute overdoses of apixaban, and other direct oral anticoagulants are relatively uncommon. The number of direct oral anticoagulants prescriptions in the United States is increasing, however reports on patient outcomes after documented overdose are sparse. Case report: A 76-year-old man with a past medical history of atrial fibrillation and taking apixaban 5\u00a0mg twice daily presented to the emergency department 10\u00a0hours after reportedly ingesting 60-70 of his pills. He was alert and had a normal physical examination. Blood tests demonstrated an INR of 12, platelets of 161\u2009000 cells\/mm\n                    <jats:sup>3<\/jats:sup>\n                    , hemoglobin 9.7\u00a0g\/dL, and creatinine 1.81\u00a0mg\/dL. He received 60\u00a0g of activated charcoal and 4 units of fresh frozen plasma prophylactically. Initial blood apixaban concentration was 4\u2009000\u00a0ng\/mL. Repeat blood apixaban concentrations were 3\u2009000\u00a0ng\/mL and 2\u2009200\u00a0ng\/mL at 7 and 14\u00a0hours, respectively (thrapeutic range 91-321\u00a0ng\/mL for a 5\u00a0mg twice daily dose). The hybrid anti-factor Xa activity did not correlate with blood apixaban concentrations. Apixaban elimination followed first-order kinetics with an apparent elimination half-life of 14\u00a0hours in the presence of impaired renal function. He did not have any minor or major bleeding events.\n                  <\/jats:p>","DOI":"10.1177\/08971900231177570","type":"journal-article","created":{"date-parts":[[2023,5,25]],"date-time":"2023-05-25T08:37:58Z","timestamp":1685003878000},"page":"761-765","update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":6,"title":["Massive Apixaban Overdose Confirmed with Blood Concentrations and Managed Without Bleeding: A Single Case Report"],"prefix":"10.1177","volume":"37","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-5133-5869","authenticated-orcid":false,"given":"Elie","family":"Harmouche","sequence":"first","affiliation":[{"name":"Department of Emergency Medicine, Division of Medical Toxicology, Maimonides Medical Center, Brooklyn, NY, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Peter","family":"Stueve","sequence":"additional","affiliation":[{"name":"Department of Emergency Medicine, Lincoln Medical Center, Bronx, NY, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mary Ann","family":"Howland","sequence":"additional","affiliation":[{"name":"St. John\u2019s University College of Pharmacy and Health Sciences, Jamaica, NY, USA"},{"name":"New York City Poison Control Center, Department of Health and Mental Hygiene, New York, NY, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mark K","family":"Su","sequence":"additional","affiliation":[{"name":"New York City Poison Control Center, Department of Health and Mental Hygiene, New York, NY, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"179","published-online":{"date-parts":[[2023,5,25]]},"reference":[{"key":"bibr1-08971900231177570","unstructured":"Lopes RD, Alexander JH, Al-Khatib SM, et al. Apixaban for reduction in stroke and other Thromboembolic events in atrial fibrillation (ARISTOTLE) trial: Design and rationale. Am Heart JAm Heart J. 2010;159159:3311162-339. 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