Omoto Ryosuke, Umemura Yutaka, Kokubu Yuki, Kiguchi Takeyuki, Fujimi Satoshi
Division of Trauma and Surgical Critical Care Osaka General Medical Center Osaka Japan.
Acute Med Surg. 2025 Jan 9;12(1):e70036. doi: 10.1002/ams2.70036. eCollection 2025 Jan-Dec.
Warfarin, a vitamin K antagonist, is widely used for preventing and treating thromboembolic diseases. While guidelines exist for managing elevated prothrombin time-international normalized ratio (INR) in patients on warfarin, the treatment for warfarin overdose in these patients is yet to be standardized.
A 41-year-old woman ingested 230 mg of warfarin with suicidal intent, along with other medications. Initially unconscious, her INR was 1.0, and laboratory results were normal. Prophylactic continuous menaquinone-4, vitamin K2, injections were administered before the INR increased. After stopping vitamin K2 72 h later, her INR rose to 1.8, but she recovered without severe coagulopathy or bleeding, despite a high initial warfarin concentration.
This is the first case of warfarin overdose managed with prophylactic vitamin K2 injections before INR elevation, successfully preventing severe complications. Prophylactic vitamin K infusion may be a practical approach for warfarin overdose treatment in non-dependent patients.
华法林作为一种维生素K拮抗剂，被广泛用于预防和治疗血栓栓塞性疾病。虽然存在关于管理服用华法林患者凝血酶原时间-国际标准化比值（INR）升高的指南，但这些患者华法林过量的治疗方法尚未标准化。
一名41岁女性出于自杀意图服用了230毫克华法林及其他药物。最初她失去意识，INR为1.0，实验室检查结果正常。在INR升高之前预防性地持续注射甲萘醌-4（维生素K2）。72小时后停用维生素K2后，她的INR升至1.8，但尽管初始华法林浓度很高，她仍康复且未出现严重凝血障碍或出血。
这是首例在INR升高之前通过预防性注射维生素K2来处理华法林过量的病例，成功预防了严重并发症。预防性维生素K输注可能是治疗非依赖性患者华法林过量的一种实用方法。
