Warfarin or Coumadin Overdose

General or Other | Emergency Medicine | Warfarin or Coumadin Overdose (Disease)


Description

Warfarin is an anticoagulant normally used in the prevention of thrombosis and thromboembolism, the formation of blood clots in the blood vessels and their migration elsewhere in the body respectively. It was initially introduced in 1948 as a pesticide against rats and mice and is still used for this purpose, although more potent poisons such as brodifacoum have since been developed. *

Almost all overdoses occur because of errors in dosing and/or drug-drug interactions. Warfarin overdose may cause no symptoms and only be recognized on a blood test that demonstrates a high Prothrombin Time (PT) or high INR (International Normalized Ratio). However, overdoses can lead to life threatening bleeding.

Causes and Risk factors

In the early 1950s warfarin was found to be effective and relatively safe for preventing thrombosis and embolism (abnormal formation and migration of blood clots) in many disorders. It was approved for use as a medication in 1954 and has remained popular ever since; warfarin is the most widely prescribed oral anticoagulant drug in North America. Despite its effectiveness, treatment with warfarin has several shortcomings.

Diagnosis and Treatment

Many commonly used medications interact with warfarin, as do some foods (particularly fresh plant-based foods containing vitamin K) and its activity has to be monitored by blood testing for the international normalized ratio (INR) to ensure an adequate yet safe dose is taken. A high INR predisposes to a high risk of bleeding, while an INR below the therapeutic target indicates that the dose of warfarin is insufficient to protect against thromboembolic events.

Warfarin and related 4-hydroxycoumarin-containing molecules decrease blood coagulation by inhibiting vitamin K epoxide reductase, an enzyme that recycles oxidized vitamin K to its reduced form after it has participated in the carboxylation of several blood coagulation proteins, mainly prothrombin and factor VII. For this reason, drugs in this class are also referred to as vitamin K antagonists.

When administered, these drugs do not anticoagulate blood immediately. Instead, onset of their effect requires about a day before clotting factors being normally made by the liver have time to naturally disappear in metabolism, and the duration of action of a single dose of warfarin is 2 to 5 days. ...