Accidental apixaban intoxication in a 23-month-old child: a case report.


Journal

BMC pediatrics
ISSN: 1471-2431
Titre abrégé: BMC Pediatr
Pays: England
ID NLM: 100967804

Informations de publication

Date de publication:
05 12 2020
Historique:
received: 30 09 2020
accepted: 30 11 2020
entrez: 6 12 2020
pubmed: 7 12 2020
medline: 15 5 2021
Statut: epublish

Résumé

Direct oral anticoagulants, such as apixaban, are increasingly used in everyday practice in order to treat or prevent thromboembolic diseases. To date, there is no available data about apixaban pharmacokinetics in children, and no intoxication has previously been described. A 23-month-old boy, with no medical history, was admitted to the emergency department 2 h after accidentally ingesting 40 mg apixaban and 0.75 mg digoxin. No adverse event was observed. Digoxin trough level was within therapeutic values. Apixaban blood concentration increased up to 1712 μg/L at H + 6 (1000-2750 μg/L using 2-5 mg/kg of apixaban in adults). The terminal half-life was 8.2 h (6-15 h in adults). The rapid elimination may explain the absence of bleeding despite high concentrations. Despite an important intake of apixaban and a real disturbance in routine coagulation assays, no clinical sign of bleeding was observed, perhaps due to wide therapeutic range of apixaban. It may also be explained by its rapid elimination. Considering the high Cmax and a possible enteroenteric recycling, the use of activated charcoal should be considered in such situations in order to prevent eventual bleeding.

Sections du résumé

BACKGROUND
Direct oral anticoagulants, such as apixaban, are increasingly used in everyday practice in order to treat or prevent thromboembolic diseases. To date, there is no available data about apixaban pharmacokinetics in children, and no intoxication has previously been described.
CASE PRESENTATION
A 23-month-old boy, with no medical history, was admitted to the emergency department 2 h after accidentally ingesting 40 mg apixaban and 0.75 mg digoxin. No adverse event was observed. Digoxin trough level was within therapeutic values. Apixaban blood concentration increased up to 1712 μg/L at H + 6 (1000-2750 μg/L using 2-5 mg/kg of apixaban in adults). The terminal half-life was 8.2 h (6-15 h in adults). The rapid elimination may explain the absence of bleeding despite high concentrations.
CONCLUSIONS
Despite an important intake of apixaban and a real disturbance in routine coagulation assays, no clinical sign of bleeding was observed, perhaps due to wide therapeutic range of apixaban. It may also be explained by its rapid elimination. Considering the high Cmax and a possible enteroenteric recycling, the use of activated charcoal should be considered in such situations in order to prevent eventual bleeding.

Identifiants

pubmed: 33278889
doi: 10.1186/s12887-020-02448-4
pii: 10.1186/s12887-020-02448-4
pmc: PMC7718703
doi:

Substances chimiques

Anticoagulants 0
Pyrazoles 0
Pyridones 0
apixaban 3Z9Y7UWC1J

Types de publication

Case Reports Journal Article

Langues

eng

Sous-ensembles de citation

IM

Pagination

546

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Auteurs

Manon Launay (M)

Laboratoire de Pharmacologie-Toxicologie-Gaz du Sang, CHU Saint-Etienne, Albert Raimond avenue, Saint-Etienne, France. manon.launay@chu-st-etienne.fr.

Yara Nasser (Y)

Laboratoire de Pharmacologie-Toxicologie-Gaz du Sang, CHU Saint-Etienne, Albert Raimond avenue, Saint-Etienne, France.

Isabelle Maubert (I)

Laboratoire d'analyses médicales, CH Emile Roux, le Puy-en-Velay, France.

Anne-Cécile Chaux (AC)

Service de Médecine Intensive et Réanimation Pédiatrique, CHU Saint-Etienne, Saint-Etienne, France.

Xavier Delavenne (X)

Laboratoire de Pharmacologie-Toxicologie-Gaz du Sang, CHU Saint-Etienne, Albert Raimond avenue, Saint-Etienne, France.
INSERM U1059, Dysfonctions Vasculaires et de l'Hémostase, Université de Lyon, Saint-Etienne, France.

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Classifications MeSH