Hypercoagulation from Concomitant Administration of Tamoxifen and Warfarin

Q: What is the clinical evidence from this study?

Study design: Case Report. Population: Metastatic breast cancer and deep venous thrombosis (n=1). Intervention: Concomitant tamoxifen and warfarin. Primary outcome: INR elevation.

Ladan Panahi; Javier A Saenz; Nam P. Nguyen; George Udeani; Salim Surani

doi:10.7759/cureus.8114

May 14, 2020CureusOpen Access

Hypercoagulation from Concomitant Administration of Tamoxifen and Warfarin

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Key result

Concomitant administration of tamoxifen and warfarin resulted in a significant elevation of INR to a peak of 8.28, requiring warfarin discontinuation and vitamin K administration.

Why the study?

Tamoxifen increasing the anticoagulation effect of warfarin is suggested to be clinically significant, but cases have been largely undocumented.

Does concomitant administration of tamoxifen and warfarin increase the risk of elevated INR in patients with breast cancer and DVT?

Study Design

Type

Case Report (n=1)

Structured PICO

Does concomitant administration of tamoxifen and warfarin increase the risk of elevated INR in patients with breast cancer and DVT?

P

Population

A 79-year-old woman with metastatic breast cancer and DVT who developed significantly elevated INR following concomitant administration of tamoxifen and warfarin.

E

Exposure

Concomitant administration of tamoxifen 20 mg oral daily and warfarin 4-6 mg oral daily

O

Outcome

International normalized ratio (INR) elevationsafety

Concomitant use of tamoxifen and warfarin can lead to significant, prolonged elevations in INR, necessitating close monitoring and potential dose adjustments.

Limitations

Hepatic function after the motor vehicle accident may not have been thoroughly evaluated.
Possible interaction with concomitantly administered cefazolin and acetaminophen could have contributed to the INR elevation.
Hepatic function after the motor vehicle accident may not have been thoroughly evaluated
Possible interaction with concomitantly administered cefazolin
Possible minor role of concomitantly administered acetaminophen

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Implication

May warrant INR monitoring with tamoxifen-warfarin co-use; leaves open confirmation of interaction magnitude in prospective studies.

Abstract

Tamoxifen causing an increase in the anticoagulation effect of warfarin is suggested to be clinically significant, but cases so far have been largely undocumented. Current recommendations advise clinicians to proceed with caution during concomitant therapy. In the presence of other medications known to interact with warfarin, such as antibiotics, proton pump inhibitors, amiodarone, and azole antifungals, international normalized ratio (INR) elevations can possibly be exacerbated even further. We hereby present a case report and a review of significant literature on the use of tamoxifen and warfarin concurrently.

Discussion

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Cite This Study

Panahi et al. (2020) conducted a case report in Metastatic breast cancer and deep venous thrombosis (n=1). Concomitant tamoxifen and warfarin was evaluated on INR elevation. Concomitant administration of tamoxifen and warfarin resulted in a significant elevation of INR to a peak of 8.28, requiring warfarin discontinuation and vitamin K administration.

synapsesocial.com/papers/6aa35145aaaedccdac748c2d https://doi.org/10.7759/cureus.8114

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Hypercoagulation from Concomitant Administration of Tamoxifen and Warfarin

Study Design

Structured PICO

Limitations

Ask about this paper

Implication

Abstract

Discussion

Cite This Study

Hypercoagulation from Concomitant Administration of Tamoxifen and Warfarin

Study Design

Structured PICO

Limitations

Ask about this paper

Implication

Abstract

Discussion

Cite This Study

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