Diarrhea-associated over-anticoagulation in a patient taking warfarin: therapeutic role of cholestyramine.
We present a case of significant over-anticoagulation temporally associated with a bout of protracted diarrhea in a patient on warfarin therapy. Cholestyramine was utilized to interrupt the enterohepatic recycling of warfarin and for its antidiarrheal effects to prevent gastrointestinal vitamin K wasting. Cholestyramine enabled the use of very low doses of sc vitamin K1 (2 mg total) with subsequent attainment of a therapeutic International Normalized Ratio in 39 h.
Roberge
R J
RJ
Department of Emergency Medicine, St Francis Medical Center, Pittsburgh, PA 15201, USA.
Rao
P
P
Miske
G R
GR
Riley
T J
TJ
D000368:Aged; D000924:Anticholesteremic Agents / Q000627:therapeutic use*; D000925:Anticoagulants / Q000009:adverse effects*; D001774:Blood Chemical Analysis; D002792:Cholestyramine Resin / Q000627:therapeutic use*; D003967:Diarrhea / Q000188:drug therapy / Q000378:metabolism*; D004562:Electrocardiography; D004791:Enzyme Inhibitors / Q000008:administration & dosage; D005260:Female; D006400:Hematocrit; D006454:Hemoglobins / Q000032:analysis; D006801:Humans; D007958:Leukocyte Count; D010314:Partial Thromboplastin Time; D010976:Platelet Count; D011517:Prothrombin Time; D012293:Rifampin / Q000008:administration & dosage; D014812:Vitamin K / Q000008:administration & dosage; D014859:Warfarin / Q000009:adverse effects*
D000924:Anticholesteremic Agents; D000925:Anticoagulants; D004791:Enzyme Inhibitors; D006454:Hemoglobins; D002792:Cholestyramine Resin; D014812:Vitamin K; D014859:Warfarin; D012293:Rifampin