Casey Bradley, Daniels Abigail, Bahekar Amol, Patel Divyang, Chapa-Rodriguez Alejandro
Internal Medicine, Cape Fear Valley Medical Center, Fayetteville, USA.
Emergency Medicine, Campbell University School of Osteopathic Medicine, Lillington, USA.
Cureus. 2023 Jan 20;15(1):e34019. doi: 10.7759/cureus.34019. eCollection 2023 Jan.
Direct oral anticoagulants (DOACs) have been used more frequently for the prevention and management of thromboembolic disease in comparison to their predecessors. DOACs provide greater ease of administration, shorter half-lives, less monitoring, and fewer drug-drug interactions. With the rise of DOACs such as rivaroxaban, the opportunity for abuse also increases. Therefore, standardization of care based on rivaroxaban misuse must also be explored, an area in which there is not ample information. We present a case where a patient consumed a stockpile of her home medications in hopes to commit suicide. A 64-year-old female presented to the emergency department due to the ingestion of rivaroxaban 5,000 mg along with ingestion of acetaminophen 30,000 mg and isosorbide mononitrate 1000 mg in the setting of intentional self-harm with multiple declarations of being classified as Do Not Resuscitate. There have been documented cases of rivaroxaban overdose, however, there are no documented cases with levels of ingestion reaching 5,000 mg along with signs of severe bleeding. Our case study reviews the previously documented management of rivaroxaban abuse and the treatment that was given to our patient in the setting of extreme anticoagulant ingestion.
与传统药物相比，直接口服抗凝剂（DOACs）在血栓栓塞性疾病的预防和治疗中使用得更为频繁。DOACs具有给药更方便、半衰期更短、监测更少以及药物相互作用更少的特点。随着利伐沙班等DOACs的使用增加，滥用的可能性也随之上升。因此，还必须探索基于利伐沙班滥用情况的标准化治疗方案，而这方面目前还缺乏足够的信息。我们报告一例患者过量服用家中储存药物企图自杀的病例。一名64岁女性因故意自伤，服用了5000毫克利伐沙班、30000毫克对乙酰氨基酚和1000毫克单硝酸异山梨酯后被送往急诊科，并多次声明拒绝心肺复苏。虽然已有利伐沙班过量的病例记录，但尚无摄入剂量达到5000毫克且伴有严重出血迹象的病例记录。我们的病例研究回顾了先前记录的利伐沙班滥用的处理方法以及在过量摄入抗凝剂情况下给予我们这位患者的治疗措施。
