Download PDF
Open Access
CC BY 4.0 · TH Open 2025; 09: a27697862
DOI: 10.1055/a-2769-7862
Letter to the Editor

Edoxaban Overdose in a Child: Unexpected Observation of Clot Lysis

Authors

  • Mouna Sassi 

    1   Hematology Laboratory of Maternity and Neonatal Center of Monastir, Faculty of Pharmacy of Monastir, Monastir, Tunisia

  • Emna Sfar

    2   Pediatric Department, Fattouma Bourguiba University Hospital, Faculty of Medicine of Monastir, Monastir, Tunisia

  • Linda Khefacha

    1   Hematology Laboratory of Maternity and Neonatal Center of Monastir, Faculty of Pharmacy of Monastir, Monastir, Tunisia

  • Nouha Berrayana

    1   Hematology Laboratory of Maternity and Neonatal Center of Monastir, Faculty of Pharmacy of Monastir, Monastir, Tunisia

  • Radhia Haj Salem

    2   Pediatric Department, Fattouma Bourguiba University Hospital, Faculty of Medicine of Monastir, Monastir, Tunisia

  • Slaheddine Chouchane

    2   Pediatric Department, Fattouma Bourguiba University Hospital, Faculty of Medicine of Monastir, Monastir, Tunisia
Further Information
Also available at
  Permissions and Reprints

Background

Direct 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] [2] [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.



Publication History

Received: 10 September 2025

Accepted: 10 December 2025

Accepted Manuscript online:
15 December 2025

Article published online:
30 December 2025

© 2025. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution License, permitting unrestricted use, distribution, and reproduction so long as the original work is properly cited. (https://creativecommons.org/licenses/by/4.0/)

Georg Thieme Verlag KG
Oswald-Hesse-Straße 50, 70469 Stuttgart, Germany

Bibliographical Record
Mouna Sassi, Emna Sfar, Linda Khefacha, Nouha Berrayana, Radhia Haj Salem, Slaheddine Chouchane. Edoxaban Overdose in a Child: Unexpected Observation of Clot Lysis. TH Open 2025; 09: a27697862.
DOI: 10.1055/a-2769-7862
 

  • References

  • 1 Shapiro S, Bhatnagar N, Khan A, Beavis J, Keeling D. Idarucizumab for dabigatran overdose in a child. Br J Haematol 2018; 180 (03) 457-459
    Search in Google Scholar
  • 2 Ha CJ, Harmouche E, Howland MA, Su MK. Two cases of acute direct oral anticoagulant overdose without adverse effect. J Pediatr Hematol Oncol 2022; 44 (02) e447-e449
    Search in Google Scholar
  • 3 Launay M, Nasser Y, Maubert I, Chaux AC, Delavenne X. Accidental apixaban intoxication in a 23-month-old child: a case report. BMC Pediatr 2020; 20 (01) 546
    Search in Google Scholar
  • 4 Gosselin RC, Adcock DM, Bates SM. et al. International Council for Standardization in Haematology (ICSH) recommendations for laboratory measurement of direct oral anticoagulants. Thromb Haemost 2018; 118 (03) 437-450
    Search in Google Scholar
  • 5 Havrdová M, Saari TI, Jalonen J. et al. Relationship of edoxaban plasma concentration and blood coagulation in healthy volunteers using standard laboratory tests and viscoelastic analysis. J Clin Pharmacol 2021; 61 (04) 522-530
    Search in Google Scholar
  • 6 Poulakos M, Walker JN, Baig U, David T. Edoxaban: a direct oral anticoagulant. Am J Health Syst Pharm 2017; 74 (03) 117-129
    Search in Google Scholar
  • 7 Burnett AE, Mahan CE, Vazquez SR, Oertel LB, Garcia DA, Ansell J. Guidance for the practical management of the direct oral anticoagulants (DOACs) in VTE treatment. J Thromb Thrombolysis 2016; 41 (01) 206-232
    Search in Google Scholar
  • 8 Margetić S, Ćelap I, Delić Brkljačić D. et al. Chromogenic anti-FXa assay calibrated with low molecular weight heparin in patients treated with rivaroxaban and apixaban: possibilities and limitations. Biochem Med (Zagreb) 2020; 30 (01) 010702
    Search in Google Scholar
  • 9 Ahn HS, Chae H, Kim Y, Lee HK, Kim H. Heparin-calibrated anti-factor Xa assay for the measurement of direct anticoagulants such as apixaban, rivaroxaban, and edoxaban. Clin Lab 2024 70. 09
    Search in Google Scholar
  • 10 Sin CF, Chan PY, Hoo YT, Yuen WH, Wong HC. A pilot study to evaluate an international normalized ratio-derived formula in combination with heparin-calibrated anti-Xa activity in calculating a plasma edoxaban level. J Clin Med 2025; 14 (03) 1006
    Search in Google Scholar
  • 11 Zou P, Atluri A, Chang P, Goedecke M, Leil TA. Population pharmacokinetics and pharmacodynamics of edoxaban in pediatric patients. CPT Pharmacometrics Syst Pharmacol 2025; 14 (01) 118-129
    Search in Google Scholar
  • 12 Sahli SD, Castellucci C, Roche TR, Rössler J, Spahn DR, Kaserer A. The impact of direct oral anticoagulants on viscoelastic testing—a systematic review. Front Cardiovasc Med 2022; 9: 991675
    Search in Google Scholar
  • 13 Seyve L, Richarme C, Polack B, Marlu R. Impact of four direct oral anticoagulants on rotational thromboelastometry (ROTEM). Int J Lab Hematol 2018; 40 (01) 84-93
    Search in Google Scholar
  • 14 Oswald E, Stalzer B, Heitz E. et al. Thromboelastometry (ROTEM) in children: age-related reference ranges and correlations with standard coagulation tests. Br J Anaesth 2010; 105 (06) 827-835
    Search in Google Scholar
  • 15 Miller BE, Bailey JM, Mancuso TJ. et al. Functional maturity of the coagulation system in children: an evaluation using thrombelastography. Anesth Analg 1997; 84 (04) 745-748
    Search in Google Scholar
  • 16 Morishima Y, Kamisato C, Honda Y. Prolongation of clot lysis time by a direct thrombin inhibitor melagatran mediated by paradoxical enhancement of thrombin generation: comparison with a direct factor Xa inhibitor edoxaban. Blood Coagul Fibrinolysis 2021; 32 (03) 209-215
    Search in Google Scholar
  • 17 Risman RA, Shroff M, Goswami J, Tutwiler V. Dependence of clot structure and fibrinolysis on apixaban and clotting activator. Res Pract Thromb Haemost 2024; 8 (08) 102614
    Search in Google Scholar
  • 18 Lawrence MJ, Evans V, Whitley J. et al. The effects of apixaban on clot characteristics in atrial fibrillation: a novel pharmacodynamic biomarker. Pharmacol Res Perspect 2022; 10 (02) e00937
    Search in Google Scholar
  • 19 Terada R, Johnson PM, Butt AL. et al. In vitro effects of Gla-domainless factor Xa analog on procoagulant and fibrinolytic pathways in apixaban-treated plasma and whole blood. Thromb Res 2023; 230: 119-125
    Search in Google Scholar