Intentional Warfarin Overdose in a Human Patient With Liver Disease and Concurrent Pulmonary Emboli

Abstract

While there are numerous guidelines in the literature concerning the management of excess anticoagulation with oral vitamin K antagonists, clinicians are often presented with a scenario in which applying these guidelines is difficult. Given the prevalence of oral anticoagulant use and the frequency of toxicity, clinicians are likely to encounter cases of toxicity in patients with uniquely complex histories and presentation. Comorbidities that affect hemostatic physiology, such as hepatic dysfunction, make an algorithmic approach to diagnosis and management less predictable. Given the risk for serious thromboembolism and hemorrhage in this patient population, clinical guidelines must be executed in consideration of physiological knowledge and clinical experience. We present a case of intentional warfarin overdose in a human patient with liver disease and a recent history of thrombosis and hemorrhage. Our management of the patient was based on a combination of published guidelines, case series and clinical experience. Our patient helps to illustrate that the current recommendations for management of excess anticoagulation can be applied to patents with complex hemostatic systems and substantial risk for both thrombosis and hemorrhage, despite mechanism of toxicity and hepatic disease.




J Hematol. 2014;3(3):76-79
doi: http://dx.doi.org/10.14740/jh130w