CURRENT Essentials of Critical Care.pdf

244 Current Essentials of Critical Care■■■Warfarin PoisoningEssentials of Diagnosis• Bleeding from single or multiple sites, with bruising, epistaxis,gingival bleeding, hematuria, hematochezia, hematemesis, menorrhagia• Prolonged PT, normal or prolonged PTT, normal thrombin time,normal fibrinogen level• Can occur either by ingestion of warfarin (drug) or ingestion ofrodenticides containing similar agents (most rodenticides containsmall amounts of anticoagulant and rarely associated withsignificant toxicity)• Allopurinol, cephalosporin, cimetidine, tricyclic antidepressant,erythromycin, NSAIDs, ethanol increase anticoagulant actionsof warfarin and contribute to toxicityDifferential Diagnosis• Other causes of coagulopathy, including liver disease, vitaminK deficiency, disseminated intravascular coagulation, sepsis-relatedcoagulopathyTreatment• Gastric decontamination within 1 hour of ingestion• For life-threatening bleeding, immediate reversal with freshfrozen plasma, IV vitamin K• For non-life-threatening bleeding, oral or IV vitamin K in patientsnot requiring long-term anticoagulation• For non-life threatening bleeding in patients requiring subsequentlong-term anticoagulation, partial correction with freshfrozen plasma• For prolonged PT without bleeding, observation alone usuallysufficient■ PearlWarfarin can be associated with several skin abnormalities includingurticaria, purple toe syndrome, and skin necrosis.ReferenceAnsell J, et al: Managing oral anticoagulant therapy. Chest 2001;119(1Suppl):22S. [PMID: 11157641]