Key result
Self-increased warfarin dosage to 5 mg daily resulted in an INR of 16 and diffuse alveolar hemorrhage in a patient with COPD and atrial fibrillation.
Case Report (n=1)
Highlights a rare and severe complication of diffuse alveolar hemorrhage resulting from warfarin overdose.
Alerts clinicians to bleeding risk from patient-initiated warfarin escalation; leaves open optimal strategies to prevent self-adjustment in anticoagulated patients.
We herein present the case of a patient with frank hemoptysis and hematuria, dyspnea, and cough. The patient was known to be affected by Chronic Obstructive Pulmonary Disease (COPD) and dilated cardiomyopathy with atrial fibrillation. For this latter condition, he was supposed to take 1.25 mg warfarin daily. Laboratory findings revealed very high levels of International Normalized Ratio (INR) (16), and the patient referred that he self-increased warfarin dose to 5 mg daily since 8 days before the onset of symptoms. Computed tomography scan revealed diffuse bilateral signs of alveolar hemorrhage with hydroaerial levels within emphysematous cysts. Wafarin was immediately stopped and changed with 220 mg dabigatran daily, and he was properly treated to restore a normal coagulation status. We concluded for a case of diffuse alveolar hemorrhage because of warfarin overdose.
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Heffler et al. (2015) conducted a case report in Warfarin overdose and diffuse alveolar hemorrhage (n=1). Warfarin overdose was evaluated on Diffuse alveolar hemorrhage. Self-increased warfarin dosage to 5 mg daily resulted in an INR of 16 and diffuse alveolar hemorrhage in a patient with COPD and atrial fibrillation.
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