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A 67-year-old man with epistaxis, melena, gross haematuria and haemarthrosis

Title
A 67-year-old man with epistaxis, melena, gross haematuria and haemarthrosis
Authors
Lee, D. H.Choi, Y. H.
Ewha Authors
최윤희
SCOPUS Author ID
최윤희scopus
Issue Date
2015
Journal Title
HONG KONG JOURNAL OF EMERGENCY MEDICINE
ISSN
1024-9079JCR Link
Citation
vol. 22, no. 5, pp. 324 - 327
Keywords
Anticoagulantpoisoningsuperwarfarinvitamin K
Publisher
MEDCOM LTD
Indexed
SCIE; SCOPUS WOS scopus
Abstract
Superwarfarins are widely used as rodenticides. They are similar to warfarin, but they are more potent and act longer. In case of poisoning, they cause severe bleeding, usually from multiple sites. Prolonged treatment with high doses of vitamin K and/or fresh frozen plasma (FFP) transfusions may be necessary. Awareness of the problem of superwarfarin intoxication among physicians remains low and cases may go undiagnosed for days or weeks, resulting in increased morbidity and even mortality. We presented a case of delayed diagnosis of superwarfarin ingestion. The patient presented to emergency department with epistaxis, melena, and gross haematuria. He was treated with vitamin K and the International Normalised Ratio (INR) dropped from >7.0 to 1.4. The patient was discharged. However, 3 weeks later, the patient presented with haemarthrosis. Blood investigation revealed INR value >7.0 again. The patient finally received treatment with FFP and vitamin K. This case illustrates the importance to consider superwarfarin ingestion when patients presented with poisoning with coagulopathy.
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의학전문대학원 > 의학과 > Journal papers
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