Which of the following drug was most likely administered IV to the patient here?
A 51-year-old man was admitted to the hospital because he found red blood in his stools and pink urine. Two weeks previously the man had started a treatment with warfarin for recurrent deep venous thrombosis. On physical examination, the patient appeared pale and diaphoretic. Vital signs were: blood pressure 85/55 mm Hg, heart rate 105 BPM, respirations 20/min. An appropriate therapy was started.
A. Vitamin K B. Aminocaproic acid C. Protamine sulfate D. Alteplase E. Fresh frozen plasma
Fresh frozen plasma-learning objective: chose the appropriate therapy for a patient suffering from severe warfarin overdose. answer: e
the symptoms of the patient strongly suggest a hemorrhagic complication of warfarin therapy. the standard treatment of warfarin overdose would be vit k but the patient is diaphoretic and hypotensive suggesting that bleeding is life-threatening. in this case the action of vit k is too slow to be useful (onset is delayed for 6 hours and is complete by 24 hours). fresh frozen plasma (which contains prothrombin, factor vii, ix and x) or activated clotting factors should be administered in case of severe acute bleeding due to anticoagulant therapy.
a) (see explanation above)
b, c, d) these drug are either useless, or dangerous, in bleeding disorders.