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Overdose: The main anticipated effect of rivaroxaban in overdose is hemorrhage; however, in several cases of significant overdose with rivaroxaban, bleeding did not occur.
Mild to moderate toxicity: Treatment is symptomatic and supportive. Monitor for evidence of bleeding.
Severe toxicity: Treatment is symptomatic and supportive. An antidote (ie, coagulation factor Xa) has been developed and may be indicated in patients that require reversal of anticoagulation following a clinically significant rivaroxaban exposure. Transfusion of packed red cell and fresh frozen plasma may be indicated in patients with severe bleeding.
Consider activated charcoal after a recent potentially toxic ingestion and if the patients are able to maintain their airway or if the airway is protected.
