Reactions 1704, p30 - 2 Jun 2018
Various toxicities: case report
A 48-year-old woman developed unresponsive, anti-
cholinergic symptoms and macroscopic haematuria following
an overdose of apixaban. Additionally, she also developed
decreasing gastrointestinal motility, that resulted in
requirement of longer time to normalise her coagulation tests
secondary to amitriptyline poisoning, possibly due to overdose
[not all durations of treatment to reaction onsets not stated].
The woman, who had hypertension, hypothyroidism and
depression, ingested apixaban 210mg and amitriptyline
unknown amount, at most 2.5g [exact dosage not stated] along
with levothyroxine-sodium [levothyroxine]. Approximately
13h later, she was found unresponsive on her kitchen floor.
Two months before, she was prescribed apixaban for bilateral
pulmonary embolism. She was admitted to a high dependency
unit following her unresponsiveness. She developed anti-
cholinergic symptoms and mild transient macroscopic
haematuria. Later, she was discharged from the hospital
without any major bleeding. However, her coagulation tests
took longer time to normalise due to associated amitriptyline
poisoning, possibly due to overdose which decreased her
gastrointestinal motility [not all outcomes stated].
Author comment: "We present a case that together with
Leikin et al.’s report sheds light on the pharmacokinetics of
massive apixaban overdose." "Our patient’s coagulation tests
took longer time to normalize . . . possibly due to concurrent
amitriptyline poisoning decreasing gastrointestinal motility."
Ilicki J, et al. Massive apixaban overdose - A comparison of three cases. American
Journal of Emergency Medicine 36: 891-893, No. 5, May 2018. Available from:
URL: http://doi.org/10.1016/j.ajem.2017.09.035 - Sweden
Reactions 2 Jun 2018 No. 17040114-9954/18/1704-0001/$14.95 Adis © 2018 Springer International Publishing AG. All rights reserved