Abstract

WARFARIN TOXICITY WITH CHRONIC KIDNEY DISEASE: A CASE REPORT

Johnson V. Babu*, Timy Thomas, Neha Maria Augustine, Arpith Antony and K. S. Irfan

Abstract

Background: Warfarin, a coumarin derivate which is the first anticoagulant used is a vitamin K antagonist mainly used as an anticoagulant. Unintentional toxicity is due to dosing, diet plan, drug interaction and liver disease. Not only these factors but also genetic polymorphisms can also affect the toxicity. The treatment or management of patients who had warfarin toxicity can vary based on their number of clinical symptoms or factors. Case Presentation: A 79-year-old male patient with 68 kg and 163 cm height was admitted in tertiary care hospital, with chief complaints of bleeding tendency, history of fall on the day before hospitalisation and history of blood in stool. Diagnosed as warfarin toxicity (Drug induced lower Gastric bleeding), Diabetes mellitus II, Chronic obstructive pulmonary disease, Atrial fibrillation, and Chronic kidney disease using physical and laboratory examination. Warfarin was stopped and administered vitamin K along with other regular medicines. Also converted the diet from normal to diabetic diet. The patient treated with fresh frozen plasma transfusion, Vitamin K, Insulin, Oral antihyperglycemic agent, antiplatelets, statins, diuretics and other supportive measures. Cardiology and nephrology management done as per advice. Discussion: The patients who are on warfarin need for a better communication between patient and health care providers by means of providing counselling regarding all aspects of medications as well as lifestyle modifications and by giving patient information leaflets.

Keywords: Warfarin Toxicity, INR. Drug induced GI Bleed.