Why the study?
Does concomitant administration of toremifene affect warfarin dosing and safety in a patient with a prosthetic valve?
Does concomitant administration of toremifene affect warfarin dosing and safety in a patient with a prosthetic valve?
Concomitant use of warfarin and toremifene may require a significant warfarin dose reduction (approximately 37.5%) to maintain stable INR without serious bleeding.
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Requires close INR monitoring if combining toremifene with warfarin; single case leaves open interaction magnitude and generalizability.
WHAT IS KNOWN AND OBJECTIVE: Antiestrogen agents have been reported to enhance the anticoagulant activity of warfarin. The use of tamoxifen with warfarin has been contraindicated. However, warfarin in combination with toremifene has not been reported. We report a case in which warfarin was combined with toremifene and applied warfarin dose prediction models to predict the dose of warfarin. CASE SUMMARY: We report the case of a 50-year-old woman with a history of breast cancer, who underwent long-term toremifene therapy after mastectomy. The patient was treated with warfarin after prosthetic valve replacement and had a fluctuating international normalized ratio (INR) following the concomitant administration of toremifene. We applied the warfarin dose prediction model to adjust the warfarin dose during treatment. Finally, her INR stabilized with a lower dose of warfarin, and there was no serious bleeding during the 1-year follow-up. WHAT IS NEW AND CONCLUSION: Warfarin does not have a serious interaction with toremifene in this case, but it needed about 37.5% dose reduction which was comparable to the interaction of some common antibiotics with warfarin.
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Peng et al. (2022) studied this question.
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