March Katherine L, Patel Kruti S, Twilla Jennifer D
Methodist University Hospital, 1265 Union Ave., Memphis, TN 38104, USA; Department of Clinical Pharmacy, University of Tennessee Health Science Center, 881 Madison Ave., Memphis, TN 38163, USA.
Department of Medicine, University of Tennessee Health Science Center, 910 Madison, Suite 1002, Memphis, TN 38163, USA.
Case Rep Hematol. 2016;2016:7095251. doi: 10.1155/2016/7095251. Epub 2016 Dec 4.
Treatment strategies for acute toxicity following massive ingestion of warfarin are not well described in the literature. 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 options include phytonadione (vitamin K), fresh frozen plasma (FFP), and prothrombin complex concentrates (PCCs) used alone or in combination. FFP and PCC can be associated with volume complications, undesirable thromboembolic events, and increased costs. 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. 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.
关于大量摄入华法林后急性中毒的治疗策略，文献中描述并不充分。华法林是治疗血栓栓塞性疾病的主要口服抗凝剂，急性中毒患者有发生危及生命出血的风险。治疗选择包括单独或联合使用维生素K、新鲜冰冻血浆（FFP）和凝血酶原复合物浓缩剂（PCC）。FFP和PCC可能会引发容量相关并发症、不良血栓栓塞事件并增加成本。我们描述了一例63岁女性因大量摄入华法林（420毫克 - 450毫克）企图自杀而导致急性华法林中毒的病例。到达急诊科后，开始进行系列国际标准化比值（INR）检查以指导给药策略，随后仅根据维生素K治疗后的INR反应进行调整。
