A super-geriatric patient with gastrostomy underwent life-threatening prothrombin time-international normalized ratio prolongation by warfarin following fasting and antibiotic therapy.
Misa SaekiAyako WatanabeKenji MomoYuka KashiwabaraTatsuki IhaTakuya NagataAkiko FujiwaraKatsumi TanakaPublished in: Clinical case reports (2023)
Geriatric and Asian-descent patients are more sensitive to the effects of warfarin, a key anticoagulant drug. In this report, we present a 97-year-old bedridden woman being treated with warfarin for cardiogenic cerebral infarction and femoral neck replacement as part of in-home medical care with a gastrostomy and was admitted to our hospital after developing pneumonia. We discontinued warfarin and started antibiotics, and her pneumonia-related symptoms improved. Eleven days after restarting warfarin, the patient's PT-INR surpassed the upper limit for measurement (over 10). We considered the mechanism might be triggered by (1) fasting, low nutrition status; and (2) antibiotics secondary to risk factors such as gastrostomy and being a super-geriatric woman. We recommend careful monitoring of PT-INR in patients treated with warfarin and antibiotics, especially in the setting of gastrostomy or older persons.
Keyphrases
- atrial fibrillation
- venous thromboembolism
- direct oral anticoagulants
- oral anticoagulants
- case report
- risk factors
- healthcare
- end stage renal disease
- physical activity
- ejection fraction
- hip fracture
- stem cells
- type diabetes
- metabolic syndrome
- blood pressure
- extracorporeal membrane oxygenation
- community acquired pneumonia
- patient reported
- community dwelling
- respiratory failure