SOBREDOSIS DE WARFARINA: REPORTE DE CASO
Date
Journal Title
Journal ISSN
Volume Title
Publisher
Rev. Méd. La Paz
Abstract
La intoxicación por warfarina es poco común, pero puede provocar hemorragias potencialmente mortales. Lo ideal sería la dosis adaptada de vitamina K que da como resultado un INR terapéutico hasta que las concentraciones de warfarina se normalicen. Sin embargo, dicho método de tratamiento puede complicarse con rebote de INR y resistencia a warfarina. Presentamos el caso de un varon de 75 años con historial de hábito alcohólico que inició tratamiento con warfarina, concomitante a fluoxetina. Presentó un INR>10 con hemorragia mayor que se revirtió satisfactoriamente al tratamiento conservador con vitamina K y Plasma fresco congelado. La sobredosis en pacientes con tratamiento de anticoagulación oral asociado a una patología de base hace más complicado el tratamiento por la dificultad de alcanzar una reversión total. La heparinización es una opción adecuada hasta restablecer la warfarinización, pero prolonga la hospitalización. Un evento como el que se presenta puede cursar con diferentes complicaciones, susceptibles de exponer al paciente a una situación crítica con riesgo vital inminente; por lo que, un diagnóstico precoz y acciones terapeúticas oportunas pueden prevenir este riesgo.
Warfarin poisoning is uncommon but it can cause life-threatening bleeding. Vitamin K adapted dose resulting in a therapeutic INR until warfarin concentrations normalize would be ideal, however, this method can be complicated by a INR rebound and warfarin resistance. We present the case of a 75-year-old man with history of alcoholic consumption who started treatment with warfarin, concomitant to fluoxetine. Patient presented an INR>10 with major hemorrhage which successfully reverted after the conservative treatment with vitamin K and fresh frozen plasma. Overdose in patients who have an oral anticoagulant treatment associated to an underlying pathology makes treatment more complicated due to the difficulty of achieving a total reversal. Heparinization is an adequate option until warfarinization is restored, but leads to a prolonged hospitalization. As in this case report, events may occur with different complications exposing patients to a critical situation with imminent life risk; therefore, early diagnosis and timely therapeutic actions can prevent it.
Warfarin poisoning is uncommon but it can cause life-threatening bleeding. Vitamin K adapted dose resulting in a therapeutic INR until warfarin concentrations normalize would be ideal, however, this method can be complicated by a INR rebound and warfarin resistance. We present the case of a 75-year-old man with history of alcoholic consumption who started treatment with warfarin, concomitant to fluoxetine. Patient presented an INR>10 with major hemorrhage which successfully reverted after the conservative treatment with vitamin K and fresh frozen plasma. Overdose in patients who have an oral anticoagulant treatment associated to an underlying pathology makes treatment more complicated due to the difficulty of achieving a total reversal. Heparinization is an adequate option until warfarinization is restored, but leads to a prolonged hospitalization. As in this case report, events may occur with different complications exposing patients to a critical situation with imminent life risk; therefore, early diagnosis and timely therapeutic actions can prevent it.
Description
Vol. 25, No. 2