Warfarin Overdose: Pharmacology, Pathophysiology, and Evidence-Based Management

Authors

  • Abdullah Muelah Pharmacy Technician, Armed Force Hospital Southern Region, Khamis Mushait, Asir
  • Hassan Dafar Alshahri Pharmacy Technician, Armed Force Hospital Southern Region, Khamis Mushait, Asir
  • Saeed Faleh Alshahrani Pharmacist, Armed Force Hospital Southern Region, Khamis Mushait, Asir
  • Abdulrahman Mohammed M Al Muslih Pharmacist, Armed Force Hospital Southern Region, Khamis Mushait, Asir
  • Saad Abdulrahman Saad Alyali Pharmacist, Armed Force Hospital Southern Region, Khamis Mushait, Asir

DOI:

https://doi.org/10.29070/wb6x8y74

Keywords:

Warfarin overdose, anticoagulation, vitamin K, prothrombin complex concentrate, international normalised ratio (INR), fresh frozen plasma (FFP), intracranial hemorrhage, gastrointestinal bleeding, thromboembolism, warfarin reversal, bleeding risk, pharmacokinetics, CYP2C9, vitamin K antagonists

Abstract

Warfarin, a commonly used oral anticoagulant, is indispensable for preventing thromboembolic disorders. However, due to its narrow therapeutic window and significant interaction potential, overdose poses serious risks of hemorrhage. This paper explores the pharmacodynamics of warfarin, the pathophysiological mechanisms leading to overdose, clinical manifestations, and evidence-based management. Treatment strategies such as Issues related to vitamin K supplementation, PCC, and FFP are considered., along with novel agents. A case series illustrates the practical management and outcomes of warfarin overdose, contributing to clinical understanding and highlighting the need for vigilant monitoring and individualized treatment.

References

Holbrook, A. M., Pereira, J. A., Labiris, R., et al. (2005). Systematic overview of warfarin and its drug and food interactions. Archives of Internal Medicine, 165(10), 1095-1106. doi:10.1001/archinte.165.10.1095

Ansell, J., Hirsh, J., Hylek, E., et al. (2008). Pharmacology and management of the vitamin K antagonists: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines (8th Edition). Chest, 133(6 Suppl), 160S-198S. doi:10.1378/chest.08-0670

Crowther, M. A., &Warkentin, T. E. (2008). Managing bleeding in anticoagulated patients with warfarin. Hematology American Society of Hematology Education Program, 2008(1), 266-271. doi:10.1182/asheducation-2008.1.266

Pirmohamed, M. (2006). Warfarin: Almost 60 years old and still causing problems. British Journal of Clinical Pharmacology, 62(5), 509-511. doi:10.1111/j.1365-2125.2006.02806.x

Levi, M., Moore, K. T., Castillejos, C. F., et al. (2016). Comparison of three-factor and four-factor prothrombin complex concentrates in reversing warfarin anticoagulation: A systematic review and meta-analysis. Journal of Thrombosis and Haemostasis, 14(4), 595-603. doi:10.1111/jth.13242

Makris, M., Van Veen, J. J., Tait, C. R., et al. (2013). Guideline on the management of bleeding in patients on antithrombotic agents. British Journal of Haematology, 160(1), 35-46. doi:10.1111/bjh.12102

Schulman, S., Kearon, C., & Subcommittee on Control of Anticoagulation of the Scientific and Standardization Committee of the ISTH. (2005). Definition of major bleeding in clinical investigations of antihemostatic medicinal products in non-surgical patients. Journal of Thrombosis and Haemostasis, 3(4), 692-694. doi:10.1111/j.1538-7836.2005.01204.x

You, J. J., Singer, D. E., Howard, P. A., et al. (2012). Antithrombotic therapy for atrial fibrillation: Antithrombotic Therapy and Prevention of Thrombosis, 9th edition: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines. Chest, 141(2 Suppl), e531S-e575S. doi:10.1378/chest.11-2304

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Published

2024-10-01

How to Cite

[1]
“Warfarin Overdose: Pharmacology, Pathophysiology, and Evidence-Based Management”, JASRAE, vol. 21, no. 7, pp. 34–37, Oct. 2024, doi: 10.29070/wb6x8y74.

How to Cite

[1]
“Warfarin Overdose: Pharmacology, Pathophysiology, and Evidence-Based Management”, JASRAE, vol. 21, no. 7, pp. 34–37, Oct. 2024, doi: 10.29070/wb6x8y74.