Case report on acute warfarin overdose and its clinical management

Abstract

Background. Studies on long-term warfarin therapy have shown a significantly higher incidence of adverse reactions in patients over 65 years old, with approximately 10% having a documented history of multiple hospitalizations due to severe hemorrhagic events directly caused by anticoagulant overdose. Objective(s). To present a clinical case illustrating the progression of warfarin overdose in a patient, focusing on symptoms, possible complications, and effective management strategies. Materials and methods. Extensive clinical and paraclinical information was gathered from patient X’s medical records, encompassing a thorough medical history, laboratory findings, imaging examinations, and clinical progression. Moreover, an in-depth review of the existing literature on comparable cases of warfarin overdose was performed to support the analysis. Results. Patient X, 67 years old, presented with constrictive retrosternal chest pain, moderate exertional dyspnea, and palpitations. Her history includes rheumatic valvular heart disease, mitral valve replacement, tricuspid valve annuloplasty, and paroxysmal atrial fibrillation. She was on warfarin 7.5 mg/day. Laboratory tests revealed critical values: prothrombin index 0%, INR 12.10, APTT 94.8 seconds, platelets 299×10⁹/L, and ESR 48.21 mm/h. Frozen plasma transfusion was indicated. During hospitalization, the prothrombin index and INR gradually improved from 0% to 25.8% and from 12.1 to 2.64, respectively; APTT at discharge was 36.2 seconds. Conclusion(s). The presented case emphasizes the crucial role of regular monitoring of both the prothrombin index and INR levels in preventing serious hemorrhagic complications. Timely medical intervention and proper management of anticoagulant overdose significantly improve patient survival rates.