Emergency rapid reversal of coumarin associated over-anticoagulation in a case of ruptured ovarian hemorrhagic cyst for surgery: A case report

Over-anticoagulation with coumarins is not uncommon in poorly followed-up patients whose international normalized ratio (INR) is not regularly monitored. Various treatment options available for emergency reversal of over-anticoagulation are either used alone or in tandem. A 36-year-old female with a history of aortic valve replacement came with complaints of severe generalized abdominal pain and hematuria. Hemoglobin was 5 mg/dL, and the INR value was >27.5. Ultrasonography had left a ruptured hemorrhagic ovarian cyst with hemoperitoneum. With a hematology consult, various products were used to reverse the over-anticoagulation. Two liters of hemoperitoneum drainage and left salpingo-oophorectomy were done laparoscopically. Post-surgical recovery was unremarkable, INR was stabilized, and 2 days later, the patient was shifted to the ward. As an anesthetist and critical care physician, it is important to stabilize, optimize, diagnose, and treat these conditions with the aid of various other specialties in a limited amount of time to prevent adverse events that can be fatal.