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LETTER TO EDITOR
Year : 2019  |  Volume : 8  |  Issue : 9  |  Page : 3071  

Warfarin overdose with a side of munchausen


Saint James School of Medicine, 1480 Renaissance Drive, Park Ridge, Chicago, Illinois, USA

Date of Submission29-Jun-2019
Date of Decision21-Jul-2019
Date of Acceptance22-Aug-2019
Date of Web Publication30-Sep-2019

Correspondence Address:
Dr. Denelle Mohammed
Saint James School of Medicine, 1480 Renaissance Drive, Suite 300, Park Ridge, IL 60068
USA
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/jfmpc.jfmpc_509_19

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How to cite this article:
Mohammed D. Warfarin overdose with a side of munchausen. J Family Med Prim Care 2019;8:3071

How to cite this URL:
Mohammed D. Warfarin overdose with a side of munchausen. J Family Med Prim Care [serial online] 2019 [cited 2019 Oct 19];8:3071. Available from: http://www.jfmpc.com/text.asp?2019/8/9/3071/268038



Dear Sir,

The article entitled, “Dying to be Ill: Munchausen meets warfarin overdose” was an illuminating and interesting read. The article evaluated a method of warfarin overdose that is not typically at the top of the list for many physicians. I commend the authors on publication of a piece that embodies several aspects of primary care in one case report.

I wish to provide some added information about treatment of warfarin overdose based on severity. For minor bleeding, withholding warfarin with observation is more than enough. The treatment of warfarin overdose with severe bleeding usually begins with slow infusion of 10 mg of Vitamin K intravenously typically over the course of 20 to 60 minutes.[1] For more severe cases of bleeding, including those with an INR>2 as seen in this case report, patients should be treated with 4-factor prothrombin complex concentrate. The dosage for patients with an INR greater than 6, such as the patient in this case report is 50 units/kg.[2] When treatment has commenced, the only thing left to do is monitor patients with PT/INR at 30-minute intervals.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Leissinger CA, Blatt PM, Hoots WK, Ewenstein B. Role of prothrombin complex concentrates in reversing warfarin anticoagulation: A review of the literature. Am J Hematol 2008;83:137.  Back to cited text no. 1
    
2.
Holbrook A, Schulman S, Witt DM, et al. Evidence-based management of anticoagulant therapy: Antithrombotic Therapy and Prevention of Thrombosis, 9th ed: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines. Chest 2012;141:e152S.  Back to cited text no. 2
    




 

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