Clinical Toxicology Case Presentation. Dr.K.Go UCH 16/2/2005. A Bleeding Case. F/73 Known CRHD with valvular replacement/AF On warfarin 4mg/4.5mg alt day History of GIB a month ago OGD – gastritis / Colonoscopy - NAD c/o PRB once P/E
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Clinical Toxicology Case Presentation
Dr.K.Go UCH 16/2/2005
BP 123/68, Pulse 79
Hb 9.8 g/dl, similar to CBP a month ago
Haemodynamically stable during AED stay and no evidence of further PRB
What is your management ?
Mx in the AED
Consider Vit K 1-2.5mg orally if bleeding .
If con’t bleeding , consider FFP & Vit K 10mg SC
All along – no more PRBHb - stable
How warfarin works ?
Vitamin K Quinol
Vitamin K 2,3 epoxide
Action of warfarin
Metabolism by 2C9, 1A2, 3A4, 2C19High Protein Bound
Active Factor 2,7,9,10Protein C,S
Vitamin K Quinone
Vitamin K supply
% of clotting factor loss
Shortest T1/2 –Factor VII ~ 5 hrs
About 3 T1/2 to see effect of ↓INR
Why our patient got supra-therapeutic INR ?
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