Case files of the medical toxicology fellowship at banner good samaritan medical center in Phoenix, AZ: A non-warfarin anticoagulant overdose

Abstract

A 50-year-old man presented to the emergency department (ED) following an overdose of his "blood thinners." The patient had become increasingly depressed over financial concerns, prompting a suicide attempt. He declined to provide any details regarding his current medications or his past medical history. A review of the computerized medical record, however, revealed he had a Factor V Leiden mutation with multiple venothromboembolic events. He previously had an inferior vena cava filter placed, and had received tissue plasminogen activator (tPA) for a cerebrovascular accident. A toxicology consult was obtained in the ED.

A meta-analysis on anticoagulation after vascular trauma

“…The mechanisms for anticoagulants are well described in the literature and are widely used for a spectrum of conditions [6][7][8][9][10][11][12][13][14]. Ever since its discovery, heparin has been an essential element in elective peripheral vascular surgery.…”

Anticoagulation Drug Therapy: A Review

“…16 Unfractionated heparin also has some inhibition on factors IXa, XIa, XIIa. 17 Low molecular weight heparins (LMWH), which also bind AT3, are smaller and have a higher proportional impact on Xa, versus IIa, in a 3:1 or 2:1 ratio. 16 , 17 As a result of this inhibition, both the UFH and LMWH ultimately inhibit thrombin activation.…”

“…Compared with UFH, the LMWH have the advantage of a more predictable dose-response curve. 17 Consequently, the LMWHs are administered at a fixed dose, based on total body weight, and do not require tight regulation and monitoring as is indicated with warfarin and UFH. 17 These drugs have near 100% bioavailability and reach peak levels 2–4 hours after subcutaneous administration.…”

“… 17 Consequently, the LMWHs are administered at a fixed dose, based on total body weight, and do not require tight regulation and monitoring as is indicated with warfarin and UFH. 17 These drugs have near 100% bioavailability and reach peak levels 2–4 hours after subcutaneous administration. 9 , 17 They have a half-life of 3–4 hours and are eliminated primarily (80%) via renal clearance, thus necessitating dose reduction considerations in patients with renal insufficiency.…”

“… 17 These drugs have near 100% bioavailability and reach peak levels 2–4 hours after subcutaneous administration. 9 , 17 They have a half-life of 3–4 hours and are eliminated primarily (80%) via renal clearance, thus necessitating dose reduction considerations in patients with renal insufficiency. 9 Additionally, since dosing is based on total body weight, rather than ideal body weight, dosing complications arise in obese patients.…”