Warfarin
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Over anticoagulation in an elderly patient: case report A 75-year-old man with severe hypothyroidism developed over anticoagulation while receiving warfarin [Coumadin] for thrombosis prophylaxis. The man, who had a history of heart valve replacement, was receiving warfarin 5mg [frequency, route and duration of therapy to reaction onset not stated]. He presented with a 3-day history of dyspnoea, throat pain and hoarseness. He had a BP of 78/35mm Hg, an HR of 42 beats/min and a temperature of 98.7°F. Examination revealed diffuse oedema of the neck and blood clots in his mouth. Neck CT revealed subcutaneous and parapharyngeal swelling of the soft tissue, as well as pharyngeal and laryngeal wall oedema. He had an INR of 18.76. The man was intubated and received mechanical ventilation for acute respiratory failure. Fresh frozen plasma and vitamin K were administered. Subsequent analysis revealed an INR of 2.44, a TSH level of 52.30 mIU/L, a free thyroxine level of 0.55 ng/dL, a thyroglobulin antibody level of 295 IU/mL and a blood glucose level of 96 mg/dL. He was administered additional fresh frozen plasma and vitamin K for his INR. He also received levothyroxine sodium and hydrocortisone. His airway obstruction and diffuse swelling subsided and he was extubated after 2 days. After 7 days, his TSH had reduced to 22.9 mIU/mL and he was discharged on levothyroxine sodium. He continued to receive warfarin from hospital day 2 for prophylaxis against prosthetic mitral valve thrombosis. Kuhadiya ND, et al. Severe Hypothyroidism with Superimposed Coumadin Toxicity: Is That Right? 93rd Annual Meeting of the Endocrine Society : abstr. P3-598, 4 Jun 2011. Available from: URL: http://www.endo-society.org 803057124 USA
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Reactions 16 Jul 2011 No. 1360
