Bleeding from Self‐administration of Phenindione: a Detailed Case‐study

Abstract

A young woman presented with a 2 year history of a severe bleeding disorder and marked deficiencies in all four vitamin-K-dependent factors. Metabolic studies with tracer doses of tritium-labelled vitamin K1 suggested that the patient might be taking an oral anticoagulant; and subsequently her plasma was found to contain a substance identical to phenindione in its spectrophotometric and chromatographic properties. The half-disappearance times of factors II, IX, X were measured after the administration of a concentrate of these factors and were found to conform with published figures. The concentrate controlled the patient's excessive bruising and prolonged skin and gingival bleeding. It would therefore seem that factor VII may not be essential in reversal of the bleeding disorder induced by anticoagulant overdose.

What Is the Evidence for the Off-label Use of Recombinant Factor VIIa (rFVIIa) in the Acute Reversal of Warfarin?

“…[1][2][3][4] Twelve papers were excluded: 7 were review articles, 5-11 3 described effects of clotting factor concentrates or vitamin K and not rFVIIa, 12-14 1 compared the in vitro antifibrinolytic activity of prothrombin complex concentrates to rFVIIa, 15 and 1 was a case report of rFVIIa in a phenindione overdose. 16 Five case series, 5 case reports, 1 retrospective casecontrol, 1 retrospective chart review, and 1 database review were retrieved. There was also 1 study involving healthy volunteers that included a dose finding study followed by a randomized controlled trial.…”