When new therapies meet old challenges: tirzepatide–warfarin interaction in a mechanical mitral valve patient

Tirzepatide is a medication capable of controlling blood glucose levels through the dual agonism of GIP and GLP-1 receptors. In particular, GLP-1 reduces food intake and delays gastric emptying. We report the case of a 66-year-old woman hospitalised with a medical history notable for grade III obesity and a mechanical mitral valve prosthesis. Given the severity of obesity and the high overall cardiovascular risk, tirzepatide was initiated on the day after admission. After 10 days of therapy, routine blood tests revealed an unexpectedly significant reduction in INR values, despite the patient following a strict and stable diet. The therapeutic INR target was gradually achieved only after approximately three weeks of progressive increases in daily warfarin dosage. Although tirzepatide has no known direct effects on INR, it could indirectly influence its values by delaying gastric emptying. In patients treated concomitantly with tirzepatide and warfarin, closer INR monitoring may therefore be advisable, even in the absence of dietary or pharmacological changes.