Warfarin-Induced Coagulopathy: Is Digoxin the Culprit?

Sadaf Shabbir Kiani; Saeed Ahmad Alam; Burhan ul Haq Saqib; Raza ul Haq; Hina Munir; Amna Yousaf

doi:10.51253/pafmj.v74iSUPPL-1.10618

Authors

Sadaf Shabbir Kiani Department of Adult Cardiology, Kashmir Institute of Cardiology, Divisional Headquarter Hospital, Mirpur, AJK Pakistan
Saeed Ahmad Alam Department of Adult Cardiology, Kashmir Institute of Cardiology, Divisional Headquarter Hospital, Mirpur, AJK Pakistan
Burhan ul Haq Saqib Department of Adult Cardiology, Kashmir Institute of Cardiology, Divisional Headquarter Hospital, Mirpur, AJK Pakistan
Raza ul Haq Department of Adult Cardiology, Kashmir Institute of Cardiology, Divisional Headquarter Hospital, Mirpur, AJK Pakistan
Hina Munir Department of Adult Cardiology, Kashmir Institute of Cardiology, Divisional Headquarter Hospital, Mirpur, AJK Pakistan
Amna Yousaf Department of Adult Cardiology, Armed Forces Institute of Cardiology & National Institute of Heart Diseases/National University of Medical Sciences (NUMS), Rawalpindi, Pakistan

DOI:

https://doi.org/10.51253/pafmj.v74iSUPPL-1.10618

Keywords:

Atrial fibrillation, Digoxin toxicity, Rheumatic heart disease, Warfarin-induced coagulopathy

Abstract

Warfarin is a notorious drug for drug interactions. Certain situations like severe Mitral Stenosis and Atrial Fibrillation still necessitate the use of warfarin, which increases bleeding risk. Here, we describe a case of warfarin-induced coagulopathy which may have occurred due to unusual interaction with digoxin.

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References

Kotecha D, Bunting KV, Gill SK, Mehta S, Stanbury M, Jones JC, et al. Effect of Digoxin vs Bisoprolol for Heart Rate Control in Atrial Fibrillation on Patient-Reported Quality of Life: The RATE-AF Randomized Clinical Trial. JAMA 2020; 324(24): 2497–2508.

https://doi.org/10.1001/jama.2020.23138

Alexander P, Visagan S, Issa R, Gorantla VR, Thomas SE. Current Trends in the Duration of Anticoagulant Therapy for Venous Thromboembolism: A Systematic Review. Cureus 2021 Oct 23; 13(10): e18992. PMID: 34853735; PMCID: PMC8608253.

https://doi.org/10.7759/cureus.18992

Bhattacharyya A, Bhavnani M, Tymms DJ. Serious interaction between digoxin and warfarin. Br J Cardiol. 2002; 9(6): 356-7.

O'Reilly RA. Drugs used in disorders of coagulation. In: Katzung BG, editor. Basic and clinical pharmacology. San Francisco: Appelton & Lange; 1992. p. 464-76.

Di Minno A, Frigerio B, Spadarella G, Ravani A, Sansaro D, Amato M, et al. Old and new oral anticoagulants: Food, herbal medicines and drug interactions. Blood Reviews 2017; 31(4): 193-203.

https://doi.org/10.1016/j.blre.2017.02.001

Lisalo E. Clinical pharmacokinetics of digoxin. Clin Pharmacokinet 1977 Jan-Feb;2(1):1-16.

https://doi.org/10.2165/00003088-197702010-00001

Ershad M, Meredith A, Shah N, Khalid MM. Cardioactive Steroid Toxicity. StatPearls Publishing; 2023 Jan–. 2022 Sep 12.

W`eil J, Sen Gupta R, Herfarth H. Nonocclusive mesenteric ischemia induced by digitalis. Int J Colorectal Dis 2004 May; 19(3): 277-80. https://doi.org/10.1007/s00384-003-0552-6

Raina R, Kaushik M, Mahajan S, Thakur R, Ritin, Satish, et al. Rare Interaction of Warfarin and Digoxin in a Case of Digoxin Toxicity. J Assoc Physicians India 2020 Mar; 68(3): 85-86. PMID: 32138495.

Djohan AH, Sia CH, Singh D, Lin W, Kong WK, Poh KK. Et al. A myriad of electrocardiographic findings associated with digoxin use. Singapore Med J 2020 Jan;61(1):9-14. PMID: 32043160; PMCID: PMC7900815. https://doi.org/10.11622/smedj.2020005