Supplementary Material for: Massive Intoxication with 70 Tablets of Apixaban; A Case Report

Apixaban is a direct oral anticoagulation agent that exerts its effect through the direct inhibition of factor Xa. We treated a case of massive intoxication with 70 tablets of apixaban and have presented the clinical course of the associated anti-Xa activities. A 49-year-old woman was admitted to the emergency department approximately 1.5 h after impulsive self - intoxication with 175mg of apixaban. She developed coagulopathy with PT-INR of 3.65, APTT of 56.5 s and AT of >150% (at 1.5 h post-ingestion). The patient’s initial and peak anti-Xa activity was 17.7 IU/mL and its elimination displayed first-order kinetics with a half-life of 10.5 h. The patient’s anti-Xa activity was within the therapeutic dose range at 26 h post-ingestion, and she recovered without experiencing any bleeding complications. Her coagulopathy also returned normal level at the same timing. This result suggests that PT-INR and AT can be used as substitute markers of overwhelmed anticoagulation following massive overdose of apixaban. A case of apixaban overdose with associated anti-Xa activities was presented. There was favorable resolution of anticoagulation without specific treatments.

阿哌沙班（Apixaban）是一类通过直接抑制Xa因子（factor Xa）发挥药理作用的直接口服抗凝药物。本文报道1例因服用70片阿哌沙班引发重度中毒的病例，并对其伴随的抗Xa因子活性变化的临床进程进行了呈现。一名49岁女性患者在冲动性自行服用175mg阿哌沙班约1.5小时后被送入急诊。患者出现凝血功能障碍：服药后1.5小时的检测结果显示，其凝血酶原时间国际标准化比值（PT-INR）为3.65、活化部分凝血活酶时间（APTT）为56.5s，抗凝血酶（AT）＞150%。患者的初始及峰值抗Xa因子活性为17.7 IU/mL，其消除过程符合一级动力学特征，半衰期为10.5小时。患者服药后26小时的抗Xa因子活性已处于治疗剂量范围内，且未出现任何出血并发症，顺利康复；其凝血功能障碍也于同一时间恢复至正常水平。本研究结果提示，凝血酶原时间国际标准化比值（PT-INR）与抗凝血酶（AT）可作为阿哌沙班大规模过量用药后抗凝作用过载的替代标志物。本文报道了1例伴随抗Xa因子活性监测的阿哌沙班过量中毒病例，患者未接受特殊治疗，抗凝相关异常最终得到了良好转归。