title: Extreme warfarin hypersensitivity after oophorectomy.
abstract: We report the case of a woman who developed unexplained warfarin hypersensitivity after undergoing surgery to remove her ovaries. Presurgery, the patient's international normalised ratios (INR) control was stable and uneventful but 11 days after her operation she presented with extremely high (frequently ≥10) INR. Warfarin was discontinued on day 24 postoperation but 11 days later the plasma warfarin concentration was high at 4.8 mg/l (therapeutic range 0.7-2.3 mg/l). After cessation of warfarin, she required frequent doses of oral and intravenous vitamin K1 (totalling 48 mg) as well as two doses of prothrombin complex concentrate to normalise the INR. The patient was switched from warfarin to heparin, then to dabigatran with no further thrombosis or bleeding. While on heparin, the kinetics of warfarin elimination and vitamin K status were found to be normal and the reason for the onset of the extreme sensitivity to warfarin remains unknown.
authors.affiliation: aUniversity of Manchester bDepartment of Haematology, Manchester Royal Infirmary cSerious Hazards of Transfusion UK National Haemovigilance Scheme, Manchester Blood Centre and the University of Manchester, Manchester dCentre for Haemostasis and Thrombosis, Guy's and St Thomas' NHS Foundation Trust, London, UK.
authors.forename: Verena
authors.initials: V
authors.lastname: Walsh
authors.forename: Jecko
authors.initials: J
authors.lastname: Thachil
authors.forename: Paula H B
authors.initials: PH
authors.lastname: Bolton-Maggs
authors.forename: Martin J
authors.initials: MJ
authors.lastname: Shearer
mesh_terms: D000925:Anticoagulants / Q000008:administration & dosage / Q000009:adverse effects*; D001779:Blood Coagulation Factors / Q000627:therapeutic use; D000069604:Dabigatran / Q000627:therapeutic use; D004342:Drug Hypersensitivity / Q000209:etiology* / Q000503:physiopathology / Q000628:therapy; D057915:Drug Substitution; D005260:Female; D006493:Heparin / Q000627:therapeutic use; D006801:Humans; D019934:International Normalized Ratio; D008875:Middle Aged; D010052:Ovariectomy; D054556:Venous Thromboembolism / Q000097:blood / Q000188:drug therapy* / Q000473:pathology; D014812:Vitamin K / Q000627:therapeutic use; D014859:Warfarin / Q000008:administration & dosage / Q000009:adverse effects* / Q000097:blood
chemical_list: D000925:Anticoagulants; D001779:Blood Coagulation Factors; D014812:Vitamin K; C025667:prothrombin complex concentrates; D014859:Warfarin; D006493:Heparin; D000069604:Dabigatran