"Extremely Elevated Coagulation Parameters in A Patient with End-Stage Renal Disease on Coumadin: A Case Report"

A 71-year-old patient was presented to the emergency room with nausea, abdominal pain, vomiting, and diarrhea. The patient had a history of Coumadin anticoagulation therapy, so coagulation tests were ordered. The results of the tests came back critically prolonged for the PT-INR and prolonged for the aPTT as well. The PT was 295.1 seconds, the INR value was 26.1, and the aPTT was 70.6 seconds. Prolongation of coagulation tests can have many causes. Due to the extreme prolongation of the PT and INR and clinicians’ skepticism of these results, additional investigative measures were performed. These additional measures confirmed the initial laboratory values and coumadin overdose. The patient was treated with vitamin K and quickly responded with PT/INR returning to therapeutic levels. While there are guidelines that exist for the management of therapeutic doses using the internationalized normalized ratio, it is still common for patients to have Coumadin overdoses, which can lead to fatal hemorrhagic outcomes if not caught promptly.