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Accidental Rivaroxaban Intoxication in a Boy

Some Lessons in Managing New Oral Anticoagulants in Children

Weirthein, Julieta, MD*; Scolnik, Dennis, MB ChB†‡; Milshtein, Nili Yanai, MD§; Capua, Tali, MD§; Glatstein, Miguel, MD§∥

doi: 10.1097/PEC.0000000000001392
Illustrative Cases

Novel oral anticoagulants offer equivalent or improved therapeutic profiles compared with warfarin, with less risk of bleeding, no interactions with food, and no need for routine laboratory monitoring. Caution must be exercised in using these drugs in certain patient populations, for example, renal insufficiency, those receiving additional antithrombotic therapy, those with questionable compliance, children, and those with a high risk of gastrointestinal bleeding. One of the novel oral anticoagulants, rivaroxaban, is a direct Factor Xa inhibitor, used to reduce risk of stroke and systemic embolism in patients with nonvalvular atrial fibrillation, deep vein thrombosis, and pulmonary embolism. We report a child who presented abnormal coagulation tests after unintended ingestion of 4 tablets of rivaroxaban. The patient was treated with fresh frozen plasma as well as admitted to intensive care and improved several hours later. We discuss his presentation and review of the literature on this topic.

From the *Division of Emergency Medicine, Sourasky Medical Center, Tel Aviv, Israel;

Division of Pediatric Emergency Medicine,

Division of Clinical Pharmacology and Toxicology, Department of Pediatrics, The Hospital for Sick Children, University of Toronto, Ontario, Canada;

§Division of Pediatric Emergency Medicine, Department of Pediatrics, Dana's Children Hospital, and

Division of Clinical Pharmacology and Toxicology, Ichilov Hospital, University of Tel Aviv, Israel.

Disclosure: The authors declare no conflict of interest.

Reprints: Miguel M. Glatstein, MD, Division of Pediatric Emergency Medicine, Dana-Dwek Children Hospital, Sackler School of Medicine, Tel Aviv University, 6 Weizman St, Tel-Aviv 64239, Israel (e-mail:

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