Unraveling the Interplay: Warfarin and Metronidazole Drug Interaction Dynamics

A 65 year old male patient was admitted in our hospital with complaints of breathlessness on exertion, haematemesis, history of malaena. Patient had history of loose stools 10 days back and was on tab metronidazole 400mg tid for 5 days. On general examination, there was pallor and laboratory investigations showed PT ( test ) more than 100, peripheral smear showed normocytic normochromic RBCs admixed with microcytic and macrocytic RBCs with anisopoikilocytosis showing occasional tear drop cells. Patient was on Tab Acitrom 2mg 0-0-2. Tab acitrom was stopped and patient was given Vit K, Fresh frozen plasma and Packed red blood cells transfusion. Patient's Haemoglobin started improving and PT came within normal limits. Patient improved symptomatically