KONYA UNIVERSITY MERAM MEDICINE FACULTY EMERGENCY DEPARTMENT

INTRODUCTION:
Warfarin toxicity is common and usually results from dose changes or drug interactions. There are few reported cases of intentional overdose.

CASE:
A 31 year old boy was seen in our emergency service with a history of ingesting 35 tablets of warfarin 5 mg 1.5 hour before his arrival. He was treated with gastric lavage, 50 mg activated charcoal from nasogastric route, human prothrombin complex concentrates (PCCs) 1500 IU intravenously (IV) once and Vitamin K1 10 mg/day IV for 5 days. He had follow-up until 7thday after ingestion in which INR was increased up to 2.68 on 3rd day and then decreased gradually. There hadn't been any hemorrhagic nor thrombotic complication.

DISCUSSION:
Reversion of the anticoagulant effect of vitamin K antagonists (VKAs) in cases of symptomatic overdose, active bleeding episodes, or need for emergency surgery is the most important indication for PCCs and this effect of PCCs appears to be more complete and rapid than that caused by administration of fresh frozen plasma. In the literature, PCCs also were used in case of acute warfarin ingestions without any hemorrhagic nor thrombotic complication. However, there is a low but quantifiable risk of thromboembolism in VKA-treated patients receiving PCCs for anticoagulation reversal.

CONCLUSION:
As an issue of reversal of anticoagulation of vitamin K antagonist, PCCs can be considered for selected patients in acute and large quantity ingestion of warfarin.