A PROBABLE CASE OF WARFARIN OVERDOSE DURI NG ANTIINFLAMMATORY THERAPY

Warfarin overdose leads to hypoprothrombinemia and bleeding diathesis. We report here the case of a 47 year old woman who ingested an overdo se of a non-steroidal anti-inflamatory drug, sold in Mexico under the name of Wobenzym (R), and containing, according to the manufacturer: p ancreatin, bromelin, papain, lipase, amilase, trypsin, alpha chemotryp sin and rutin. She developed skin, urinary and gastrointestinal bleedi ng and was found to be apparently under the effect of a coumadin overd ose, i.e. prolonged prothrombin time, prolonged activated thromboplast in time, and low functional and antigenic levels of prothrombin. A pla telet count, and the thrombin, reptilase and bleeding times were norma l. All laboratory and clinical abnormalities reverted to normal by usi ng fresh frozen plasma and parenteral vitamin K. In addition, we were able to show that the commercial preparation could prolong the prothro mbin time in rabbits and, by high-performance liquid chromatography, a pike consonant with purified coumadin was found in the drug. It is co ncluded that this drug is probably contaminated by coumadin, and that physicians must be aware of its potential side effects.