[{"data":1,"prerenderedAt":-1},["ShallowReactive",2],{"detail-sidebar-cat-0-en-105":3,"doc-seo-413321-105":59,"doc-detail-413321-en":130},{"code":4,"msg":5,"data":6},0,"success",[7,13,18,23,28,33,38,43,48,51,55],{"id":8,"doc_module":4,"doc_module_name":9,"category_name":10,"show_sort_weight":11,"slug":12},1,"Document","Story & Novel",90,"story-novel",{"id":14,"doc_module":4,"doc_module_name":9,"category_name":15,"show_sort_weight":16,"slug":17},2,"Literature",80,"literature",{"id":19,"doc_module":4,"doc_module_name":9,"category_name":20,"show_sort_weight":21,"slug":22},4,"Exam",70,"exam",{"id":24,"doc_module":4,"doc_module_name":9,"category_name":25,"show_sort_weight":26,"slug":27},5,"Comic",60,"comic",{"id":29,"doc_module":4,"doc_module_name":9,"category_name":30,"show_sort_weight":31,"slug":32},6,"Technology",50,"technology",{"id":34,"doc_module":4,"doc_module_name":9,"category_name":35,"show_sort_weight":36,"slug":37},7,"Healthcare",40,"healthcare",{"id":39,"doc_module":4,"doc_module_name":9,"category_name":40,"show_sort_weight":41,"slug":42},8,"Research & Report",30,"research-report",{"id":44,"doc_module":4,"doc_module_name":9,"category_name":45,"show_sort_weight":46,"slug":47},9,"Religion & Spirituality",20,"religion-spirituality",{"id":46,"doc_module":4,"doc_module_name":9,"category_name":49,"show_sort_weight":46,"slug":50},"World Cup","world-cup",{"id":52,"doc_module":4,"doc_module_name":9,"category_name":53,"show_sort_weight":52,"slug":54},10,"Lifestyle","lifestyle",{"id":56,"doc_module":4,"doc_module_name":9,"category_name":57,"show_sort_weight":24,"slug":58},19,"General","general",{"code":4,"msg":60,"data":61},"ok",{"site_id":62,"language":63,"slug":64,"title":65,"keywords":66,"description":67,"schema_data":68,"social_meta":123,"head_meta":125,"extra_data":127,"updated_unix":129},105,"en","edoxaban-overdose-in-a-child-unexpected-observation-of-clot-lysis","Edoxaban Overdose in a Child - Unexpected Observation of Clot Lysis","","Edoxaban overdose in pediatrics is rare, and management data remain limited. A 21-month-old girl ingested an estimated 180 mg edoxaban 4 hours before admission and showed no bleeding or abnormal initial blood counts, yet coagulation testing at H+4 revealed markedly prolonged PT and elevated INR, indicating systemic absorption. Clearance appeared rapid with PT normalization by H+24, supported by anti-Xa chromogenic monitoring. Viscoelastic ROTEM testing demonstrated an unexpected persistent rise in maximum lysis during the first three days, suggesting a possible novel clot-lysis phenomenon despite limited ROTEM sensitivity for DOAC quantification.",{"@graph":69,"@context":122},[70,84,105],{"@type":71,"itemListElement":72},"BreadcrumbList",[73,77,79,82],{"item":74,"name":75,"@type":76,"position":8},"https://docshare.wps.com","Home","ListItem",{"item":78,"name":9,"@type":76,"position":14},"https://docshare.wps.com/document/",{"item":80,"name":35,"@type":76,"position":81},"https://docshare.wps.com/document/healthcare/",3,{"item":83,"name":65,"@type":76,"position":19},"https://docshare.wps.com/document/edoxaban-overdose-in-a-child-unexpected-observation-of-clot-lysis/413321/",{"url":83,"name":65,"@type":85,"image":86,"author":91,"headline":65,"publisher":94,"fileFormat":97,"inLanguage":63,"description":67,"dateModified":98,"datePublished":99,"encodingFormat":97,"isAccessibleForFree":100,"interactionStatistic":101},"DigitalDocument",{"url":87,"@type":88,"width":89,"height":90},"https://docshare.wps.com/thumbnails/edoxaban-overdose-in-a-child-unexpected-observation-of-clot-lysis/413321.png","ImageObject",300,407,{"name":92,"@type":93},"mieayamfan","Person",{"url":74,"name":95,"@type":96},"DocShare","Organization","application/pdf","2026-11-06","2026-09-28",true,{"@type":102,"interactionType":103,"userInteractionCount":34},"InteractionCounter",{"@type":104},"ViewAction",{"@type":106,"mainEntity":107},"FAQPage",[108,114,118],{"name":109,"@type":110,"acceptedAnswer":111},"How was edoxaban overdose suspected and assessed in the child?","Question",{"text":112,"@type":113},"The child presented 4 hours after accidental ingestion with no bleeding but abnormal coagulation results at H+4, including prolonged PT and elevated INR, consistent with systemic edoxaban absorption. Anti-Xa activity and viscoelastic testing were then used for monitoring.","Answer",{"name":115,"@type":110,"acceptedAnswer":116},"What treatments were used to manage the overdose?",{"text":117,"@type":113},"Because gastric decontamination was considered too late, management focused on enhancing clearance. The child received intravenous hyperhydration, and prothrombin complex concentrate (PCC) was administered at H+8 as a precaution.",{"name":119,"@type":110,"acceptedAnswer":120},"What unexpected finding was observed during follow-up?",{"text":121,"@type":113},"ROTEM testing showed a persistent increase in maximum lysis (ML) up to 21% across EXTEM, INTEM, and APTEM assays during the first three days, exceeding the usual hyperfibrinolysis threshold, then decreasing by H+120.","https://schema.org",{"og:url":83,"og:type":124,"og:title":65,"og:site_name":95,"og:description":67},"article",{"robots":126,"canonical":83},"index,follow",{"doc_id":128,"site_id":62},413321,1791048222,{"code":4,"msg":5,"data":131},{"doc_id":128,"user_id":132,"nickname":92,"user_avatar":133,"doc_module":4,"category_id":34,"category_name":35,"doc_title":65,"doc_description":67,"doc_content":134,"file_id":135,"file_url":136,"file_type":137,"file_size":138,"view_count":34,"is_deleted":4,"is_public":8,"is_downloadable":8,"audit_status":8,"page_count":81,"language":139,"language_code":63,"site_id":62,"html_lang":63,"table_of_contents":140,"faqs":141,"seo_title":142,"seo_description":67,"update_tm":143,"read_time":39,"preview_page_count":4},962090893677,"https://ap-avatar.wpscdn.com/davatar_3d24733baf745e90a7e4bdd5f77d97b2","THIEME  \nAccepted Manuscript online: 2025-12-15 Article published online: 2025-12-30  \nLetter to the Editor  \n1  \nEdoxaban Overdose in a Child: Unexpected Observation of Clot Lysis  \nMouna Sassi 1 Emna Sfar2 Linda Khefacha 1 Nouha Berrayana 1 Radhia Haj Salem2 Slaheddine Chouchane2  \n1 Hematology Laboratory of Maternity and Neonatal Center of Monastir, Faculty of Pharmacy of Monastir, Monastir, Tunisia  \n2 Pediatric Department, Fattouma Bourguiba University Hospital, Faculty of Medicine of Monastir, Monastir, Tunisia  \nTH Open 2025;9:a27697862 .  \nAddress for correspondence Mouna Sassi, PharmD, Hematology Laboratory of Maternity and Neonatal Center of Monastir, Faculty of Pharmacy of Monastir, Monastir, Tunisia  \n([e-mail: mouna.bahrini@yahoo.fr](e-mail: mouna.bahrini@yahoo.fr)).  \nBackground  \nDirect oral anticoagulants (DOACs) are increasingly prescribed in adults but remain exceptional in pediatrics. Reports of overdose in children are very rare, and clinical data on management are limited.1–3 Edoxaban is a direct factor (F) Xa inhibitor, inhibiting free and bound FXa.4 We present here the first description, to our knowledge, of edoxaban overdose in a child, in whom we observed an unusual clot-lysis phenomenon that may suggest a novel mechanism of action.  \nClinical Case Summary and Management  \nA 21-month-old girl (12 kg) presented to our tertiary pediatric department 4hours post-accidental ingestion of probable 3 pills of edoxaban 60mg (180mg). Edoxaban was prescribed to her father to prevent the recurrence of thrombosis. On presentation, the clinical examination was normal. No hemorrhagic sign was identified. Initial blood tests showed normal full blood count and normal renal and liver function (creatinine 21 µmol/L, aspartate aminotransferase 28 IU/L, alanine aminotransferase 20IU/L). However, the coagulation profile at H þ4 was abnormal: prothrombin time (PT) was prolonged at 25.4 seconds, with an international normalized ratio (INR) of 2 .2, consistent with significant systemic absorption of edoxaban.  \nThe absence of bleeding was reassuring but did not exclude toxicity. Edoxaban absorption is rapid (1–3hours), so the maximum changes are generally observed 2 to 4hours after its intake.5 As gastric decontamination was deemed too late, management focused on enhancing clearance. Edoxaban half-life is 10 to 14hours in patients with normal renal  \nreceived  \nSeptember 10, 2025  \naccepted after revision December 10, 2025  \naccepted manuscript online December 15, 2025  \nDOI [https://doi.org/](https://doi.org/)[ ](https://doi.org/)[10.1055/a-2769-7862.](10.1055/a-2769-7862.)[ ](10.1055/a-2769-7862.)[ISSN](ISSN 2512-9465.)[ 2512-9465.](ISSN 2512-9465.)  \nfunction. More than two-thirds of urinary elimination occurred within 8 hours.6 Therefore, the child was started on intravenous hyperhydration at 3 L/m2/day. At H þ8, prothrombin complex concentrate (PCC, 25IU/kg) was administered as a precautionary measure.  \nProthrombin Time  \nThe child was followed up with PT, which normalized when assessed at Hþ24 (PT 12.4s/ INR 1. 1). This result likely reflected accelerated elimination in children with preserved renal function. Edoxaban had dose-dependent effects on PT, but reagents vary significantly in their sensitivities.6,7 PT can provide qualitative information if the anti-Xa assays are not available.  \nAnti-Xa Activity  \nEdoxaban monitoring with anti-Xa activity and viscoelastic tests was performed at H þ24, Hþ48, H þ72, and H þ 120. Edoxaban levels were estimated from an anti-Xa chromogenic assay using ACL TOP 550 analyzer (Instrumentation Laboratory, Bedford, MA), HaemosIL anti-Xa liquid reagent with a calibrator for unfractionated heparin (UFH) and lowmolecular-weight heparin (LMWH). Anti-Xa activity was measured using a UFH/LMWH-calibrated chromogenic assay, acknowledging the known limited accuracy of this method for edoxaban at low concentrations due to the lack of dedicated calibrators. 2,8,9 Nevertheless, the detectable level at H","cbCaiuDKX5C0754o","https://ap.wps.com/l/cbCaiuDKX5C0754o","pdf",255863,"English","# Background\n## Clinical Case Summary and Management\n## Prothrombin Time\n## Anti-Xa Activity\n## Viscoelastic Tests (ROTEM)","[{\"question\":\"How was edoxaban overdose suspected and assessed in the child?\",\"answer\":\"The child presented 4 hours after accidental ingestion with no bleeding but abnormal coagulation results at H+4, including prolonged PT and elevated INR, consistent with systemic edoxaban absorption. Anti-Xa activity and viscoelastic testing were then used for monitoring.\"},{\"question\":\"What treatments were used to manage the overdose?\",\"answer\":\"Because gastric decontamination was considered too late, management focused on enhancing clearance. The child received intravenous hyperhydration, and prothrombin complex concentrate (PCC) was administered at H+8 as a precaution.\"},{\"question\":\"What unexpected finding was observed during follow-up?\",\"answer\":\"ROTEM testing showed a persistent increase in maximum lysis (ML) up to 21% across EXTEM, INTEM, and APTEM assays during the first three days, exceeding the usual hyperfibrinolysis threshold, then decreasing by H+120.\"}]","Edoxaban Overdose in a Child - Unexpected Observation of Clot Lysis | PDF",1790594443]