Successful treatment of warfarin overdose with 20% lipid solution: a case report

Year 2023, Volume: 5 Issue: 2, 74 - 77, 06.09.2023

Damla Ernur , Bülent Serhan Yurtlu , Volkan Hancı

https://doi.org/10.55994/ejcc.1333434

Abstract

International Normalized Ratio (INR) value monitoring is important in patients using warfarin, and it is aimed to keep it in the range of 2.5-3.5 in patients with mechanical heart valves.In this case report, it is aimed to present the successful treatment of a warfarin overdose case using 20% lipid emulsion for the first time in the literature.

Keywords

20 % lipid solution, warfarin overdose, warfarin intoxication, aortic valve replacement, mitral valve replacement

References

• 1.Sucker, C., Litmathe, J. Orale Antikoagulation mit Vitamin K-Antagonisten – ein Update. Wien Med Wochenschr 168, 121–132 (2018).
• 2.Daniel M. Witt, PharmD, BCPS Is It Time to Reevaluate Current International Normalized Ratio Targets for Asian Patients Following Mechanical Heart Valve Replacement? JAMA Netw Open. 2022;5(2):e2146034.
• 3. Baumgartner H, Falk V, Bax JJ, De Bonis M, Hamm C, Holm PJ, Iung B, Lancellotti P, Lansac E, Rodriguez Muñoz D, Rosenhek R, Sjögren J, Tornos Mas P, Vahanian A, Walther T, Wendler O, Windecker S, Zamorano JL; ESC Scientific Document Group. 2017 ESC/EACTS Guidelines for the management of valvular heart disease. Eur Heart J. 2017 Sep 21;38(36):2739-2791.
• 4.Writing Committee Members, Otto CM, Nishimura RA, Bonow RO, Carabello BA, Erwin JP 3rd, Gentile F, Jneid H, Krieger EV, Mack M, McLeod C, O'Gara PT, Rigolin VH, Sundt TM 3rd, Thompson A, Toly C. 2020 ACC/AHA Guideline for the Management of Patients With Valvular Heart Disease: A Report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines. J Am Coll Cardiol. 2021 Feb 2;77(4):e25-e197. Erratum in: J Am Coll Cardiol. 2021 Feb 2;77(4):509. Erratum in: J Am Coll Cardiol. 2021 Mar 9;77(9):1275.
• 5. Fernandez AL, Lee JA, Rahilly L, Hovda L, Brutlag AG, Engebretsen K. (2011). The Use of Intravenous Lipid Emulsion as an Antidote in Veterinary Toxicology. Vet Emerg Crit Care. 21(4):309-20.
• 6. MacLaren R, Wachsman BA, Swift DK, Kuhl DA. Warfarin resistance associated with intravenous lipid administration: discussion of propofol and review of the literature. Pharmacotherapy. 1997 Nov-Dec;17(6):1331-7.
• 7. Lutomski DM, Palascak JE, Bower RH. Warfarin resistance associated with intravenous lipid administration. JPEN J Parenter Enteral Nutr. 1987 May-Jun;11(3):316-8.
• 8.Cotto MA, Lutomski DM, Palascak JE, Fant WK, LaFrance RJ. Fat emulsion effects on prothrombin time in warfarin anticoagulated patients: an in vitro study. JPEN J Parenter Enteral Nutr. 1990 Mar-Apr;14(2):201-3
• 9. Pernod G, Godiér A, Gozalo C, Tremey B, Sié P. French clinical practice guidelines on the management of patients on vitamin K antagonists in at-risk situations (overdose, risk of bleeding, and active bleeding) Thromb Res. 2010;126:e167–e174.
• 10. Chowdary GVS, Naryanan TJ, Basha PSA, Murthy TVRK, Murthy JMK. Anticoagulant-related subdural hematoma in patients with mechanical heart valves. Neurology Asia. 2005;10:13–19
• 11. Aguilar MI, Hart RG, Kase CS, Freeman WD, Hoeben BJ, García RC, Ansell JE, Mayer SA, Norrving B, Rosand J, et al. Treatment of warfarin-associated intracerebral hemorrhage: literature review and expert opinion. Mayo Clin Proc. 2007;82:82–92.
• 12. Dentali F, Ageno W, Crowther M. Treatment of coumarin-associated coagulopathy: a systematic review and proposed treatment algorithms. J Thromb Haemost. 2006;4:1853–1863.
• 13. Vang ML, Hvas AM, Ravn HB. Urgent reversal of vitamin K antagonist therapy. Acta Anaesthesiol Scand. 2011;55:507–516
• 14. Goodnough LT, Shander A. How I treat warfarin-associated coagulopathy in patients with intracerebral hemorrhage. Blood. 2011;117:6091–6099.
• 15. Levy JH, Tanaka KA, Dietrich W. Perioperative hemostatic management of patients treated with vitamin K antagonists. Anesthesiology. 2008;109:918–926.
• 16. Pabinger I, Brenner B, Kalina U, Knaub S, Nagy A, Ostermann H. Prothrombin complex concentrate (Beriplex P/N) for emergency anticoagulation reversal: a prospective multinational clinical trial. J Thromb Haemost. 2008;6:622–631.
• 17. Levi M, Levy JH, Andersen HF, Truloff D. Safety of recombinant activated factor VII in randomized clinical trials. N Engl J Med. 2010;363:1791–1800.
• 18. Morgenstern LB, Hemphill JC, Anderson C, Becker K, Broderick JP, Connolly ES, Greenberg SM, Huang JN, MacDonald RL, Messé SR, et al. Guidelines for the management of spontaneous intracerebral hemorrhage: a guideline for healthcare professionals from the American Heart Association/American Stroke Association. Stroke. 2010;41:2108–2129.
• 19. Cave G, Harvey MG. (2014). Should We Consider the Infusion of Lipid Emulsion in the Resuscitation of Poisoned Patients. Crit Care. 18(5):457.
• 20. Robben JH, Dijkman MA. (2016). Lipid Therapy for Intoxications. Vet Clin North Am Small Anim Pract. 47(2):435-440
• 21. Fettiplace MR, Weinberg G. (2015). Past, Present, and Future of, Lipid Resuscitation Therapy. J Parenter Enteral Nutr. 39(1):72-83.
• 22. Mirtallo JM, Dasta JF, Kleinschmidt KC, Varon J. (2010). State of the Art Review: Intravenous Fat Emulsions: Current Applications, Safety Profile, and Clinical Implications. Ann Pharmacother. 44(4):688-700.
• 23. Tárnoky AL. Warfarin and albumin. Br Med J (Clin Res Ed). 1982 Sep 18;285(6344):812.