Additionally, although uncommon, intentional ingestion of large doses of warfarin can lead to life-threatening acute toxicity scenarios.Īcute warfarin toxicity management is complicated by its well described pharmacokinetic profile including rapid and complete absorption, delayed anticoagulation effects, and having a 29- to 45-hour half-life. Without these efforts, patients can experience warfarin toxicity due to a multitude of reasons including dose changes, drug-drug interactions, and dietary changes.
Due to its extensive interpatient variability and narrow therapeutic range, warfarin requires frequent laboratory monitoring with International Normalized Ratio (INR) testing and close patient follow-up. While the use of new oral anticoagulation agents is on the rise, the vitamin K antagonist (VKA) warfarin remains a primary agent for oral anticoagulation in the treatment of thromboembolic disease. Upon arrival to the emergency department, serial INR checks were initiated to help guide dosing strategy and later adjusted based on INR response to treatment using only phytonadione. We describe the case of a 63-year-old female with acute warfarin toxicity following a massive ingestion of warfarin (420 mg–450 mg) in an attempt to commit suicide. FFP and PCC can be associated with volume complications, undesirable thromboembolic events, and increased costs. Treatment options include phytonadione (vitamin K 1), fresh frozen plasma (FFP), and prothrombin complex concentrates (PCCs) used alone or in combination.
Warfarin is the primary oral anticoagulation agent used in the treatment of thromboembolic disease, and patients with acute toxicity are at risk for life-threatening hemorrhages.
Treatment strategies for acute toxicity following massive ingestion of warfarin are not well described in the literature.
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