Skip to main content
Journal of Medical Toxicology logoLink to Journal of Medical Toxicology
. 2009 Dec;5(4):242–249. doi: 10.1007/BF03178275

Case files of the medical toxicology fellowship at banner good samaritan medical center in Phoenix, AZ: A non-warfarin anticoagulant overdose

Chip Gresham 1, Michael Levine 1,, Anne -Michelle Ruha 1
PMCID: PMC3550411  PMID: 19876861

Full Text

The Full Text of this article is available as a PDF (164.4 KB).

Footnotes

Notes: These was no outside funding of any kind used for this study.

References

  • 1.Fields JM, Goyal M. Venothromboembolism. Emerg Med Clin North Am. 2008;26:649–683. doi: 10.1016/j.emc.2008.04.004. [DOI] [PubMed] [Google Scholar]
  • 2.McCart GM, Kayser SR. Therapeutic equivalency of low-molecular-weight heparins. Ann Pharmacother. 2002;36:1042–1057. doi: 10.1345/aph.10264. [DOI] [PubMed] [Google Scholar]
  • 3.Jacobson AK. Platelet ADP receptor antagonists: ticlopidine and clopidogrel. Best Pract Res Clin Haematol. 2004;17:55–64. doi: 10.1016/j.beha.2004.03.002. [DOI] [PubMed] [Google Scholar]
  • 4.Angiolillo DJ. ADP receptor antagonism: what’s in the pipeline. Am J Cardiovasc Drugs. 2007;7:423–432. doi: 10.2165/00129784-200707060-00005. [DOI] [PubMed] [Google Scholar]
  • 5.Lubbe DF, Berger PB. The thienopyridines. J Interven Cardiol. 2002;15:85–94. doi: 10.1111/j.1540-8183.2002.tb01037.x. [DOI] [PubMed] [Google Scholar]
  • 6.Plosker GL, Lyseng-Williamson KA. Clopidogrel: A review of its use in the prevention of thrombosis. Drugs. 2007;67:613–646. doi: 10.2165/00003495-200767040-00013. [DOI] [PubMed] [Google Scholar]
  • 7.Quinn MJ, Fitzgerald DJ. Ticlopidine and clopidogrel. Circulation. 1999;100:1667–1672. doi: 10.1161/01.cir.100.15.1667. [DOI] [PubMed] [Google Scholar]
  • 8.Ticlid [package insert]. Nutley, NJ: Roche Laboratories Inc.; 2001.
  • 9.Abuzahra M, Pillai M, Caldera A, et al. Comparison of higher clopidogrel loading and maintenance dose to standard dose on platelet function and outcomes after percutaneous coronary intervention using drug-eluting stents. Am J Cardiol. 2008;102:401–403. doi: 10.1016/j.amjcard.2008.03.073. [DOI] [PubMed] [Google Scholar]
  • 10.Thebault JJ, Kieffer G, Cariou R. Single dose pharmacodynamics of clopidogrel. Semin Thromb Hemost. 1999;25(Suppl 2):3–8. [PubMed] [Google Scholar]
  • 11.Riley AB, Tafreshi MJ, Haber SL. Prasugrel: a novel antiplatelet agent. Am J Health-Syst Pharm. 2008;65:10019–10028. doi: 10.2146/ajhp070496. [DOI] [PubMed] [Google Scholar]
  • 12.Samama MM, Gerotziafas GT. Comparative pharmacokinetics of LMWHs. Semin Thromb Hemost. 2000;26(Suppl 1):31–38. doi: 10.1055/s-2000-9497. [DOI] [PubMed] [Google Scholar]
  • 13.George-Phillips KL, Bungard TJ. Use of low-molecular-weight heparin to bridge therapy in obese patients and in patients with renal dysfunction. Pharmacotherapy. 2006;26:1479–1490. doi: 10.1592/phco.26.10.1479. [DOI] [PubMed] [Google Scholar]
  • 14.Menajovsky LB. Heparin-induced thrombocytopenia: clinical manifestations and management strategies. Am J Med. 2005;118(Suppl 8A):21S–30S. doi: 10.1016/j.amjmed.2005.06.005. [DOI] [PubMed] [Google Scholar]
  • 15.Cheng JW. Fondaparinux: A new antithrombotic agent. Clin Ther. 2002;24:1757–1769. doi: 10.1016/S0149-2918(02)80077-7. [DOI] [PubMed] [Google Scholar]
  • 16.Keam SJ, Goa KL. Fondaparinux sodium. Drugs. 2002;62:1673–1685. doi: 10.2165/00003495-200262110-00007. [DOI] [PubMed] [Google Scholar]
  • 17.Dinwoodey DL, Ansell JE. Heparins, low-molecular-weight heparins, and pentasaccharides: use in the older patient. Cardiol Clin. 2008;26:145–155. doi: 10.1016/j.ccl.2007.12.009. [DOI] [PubMed] [Google Scholar]
  • 18.Linkins LA, Weitz JI. New anticoagulant therapy. Annu Rev Med. 2005;56:63–77. doi: 10.1146/annurev.med.56.082103.104708. [DOI] [PubMed] [Google Scholar]
  • 19.Bauer KA. New anticoagulants. Curr Opin Hematol. 2008;15:509–515. doi: 10.1097/MOH.0b013e328309ecbc. [DOI] [PubMed] [Google Scholar]
  • 20.Hirsh J, O’Donnell M, Weitz JI. New anticoagulants. Blood. 2005;105:453–463. doi: 10.1182/blood-2003-12-4195. [DOI] [PubMed] [Google Scholar]
  • 21.Agnelli G, Becattini C. New anticoagulants. Semin Thromb Hemost. 2006;32:793–802. doi: 10.1055/s-2006-955462. [DOI] [PubMed] [Google Scholar]
  • 22.Turpie AG, Gallus AS, Hoek JA, et al. A synthetic pentasaccharide for the prevention of deep-vein thrombosis after total hip replacement. N Engl J Med. 2001;344:619–625. doi: 10.1056/NEJM200103013440901. [DOI] [PubMed] [Google Scholar]
  • 23.Arixtra [package insert]. Research Triangle Park, NC: GlaxoSmith Kline; October 2008.
  • 24.Verma AK, Brighton TA. The direct factor Xa inhibitor rivaroxaban. Med J Aust. 2009;190:379–383. doi: 10.5694/j.1326-5377.2009.tb02453.x. [DOI] [PubMed] [Google Scholar]
  • 25.Gulseth MP, Michaud J, Nutescu EA. Rivaroxaban: an oral direct inhibitor of factor Xa. Am J health Syst Pharm. 2008;65:1520–1529. doi: 10.2146/ajhp070624. [DOI] [PubMed] [Google Scholar]
  • 35.Hirsh J, Raschke R. Heparin and low-molecular-weight heparin: the Seventh ACCP Conference on Antithrombotic and Thrombolytic Therapy. Chest. 2004;126(Suppl 3):188–203S. doi: 10.1378/chest.126.3_suppl.188S. [DOI] [PubMed] [Google Scholar]
  • 36.Laposata M, Green D, Van Cott EM, et al. College of American Pathologists Conference XXXI on laboratory monitoring of anticoagulant therapy: the clinical use and laboratory monitoring of low-molecular-weight heparin, danaparoid, hirudin and related compounds, and argatroban. Arch Pathol Lab Med. 1998;122:799–807. [PubMed] [Google Scholar]
  • 34.Wiernikowski JT, Chan A, Lo G. Reversal of anti-thrombin activity using protamine sulfate. Experience in a neonate with a 10-fold overdose of enoxaparin. Thromb Res. 2007;120:303–305. doi: 10.1016/j.thromres.2006.08.011. [DOI] [PubMed] [Google Scholar]
  • 37.Saw J, Kereiakes DJ, Mahaffey KW, et al. Evaluation of a novel point-of-care enoxaparin monitor with central laboratory anti-Xa levels. Thromb Res. 2003;112:301–306. doi: 10.1016/j.thromres.2004.01.006. [DOI] [PubMed] [Google Scholar]
  • 38.Robertson JD, Brandao L, Williams S, et al. Use of a single anti-Xa calibration curve is adequate for monitoring enoxaparin and tinzaparin levels in children. Thromb Res. 2008;122:867–869. doi: 10.1016/j.thromres.2008.05.012. [DOI] [PubMed] [Google Scholar]
  • 39.Nieuwenhuis HK, Albada J, Banga JD, et al. Identification of risk factors for bleeding during treatment of acute venous thromboembolism with heparin or low molecular weight heparin. Blood. 1991;78:2337–2343. [PubMed] [Google Scholar]
  • 26.Geiger J, Teichmann L, Grossman R, et al. Monitoring clopidogrel action: comparison of methods. Clin Chem. 2005;51:957–965. doi: 10.1373/clinchem.2004.047050. [DOI] [PubMed] [Google Scholar]
  • 27.Malinin A, Pokov A, Spergling M, et al. Monitoring platelet inhibition after clopidogrel with the Verify Now-P2Y12 rapid analyzer: The VERify Thrombosis Risk Assessment (VERITAS) study. Thromb Res. 2007;119:277–284. doi: 10.1016/j.thromres.2006.01.019. [DOI] [PubMed] [Google Scholar]
  • 28.Cattaneo M. Aspirin and clopidogrel: Efficacy, safety, and the issue of drug resistance. Arterioscler Thromb Vasc Biol. 2004;24:1980–1987. doi: 10.1161/01.ATV.0000145980.39477.a9. [DOI] [PubMed] [Google Scholar]
  • 29.Plavix [package insert]. Bridgewater, NJ: Bristol-Myers Squibb/Sanofi Pharmaceuticals Partnership; 2008.
  • 30.Mani H, Toennes SW, Linnemann B, et al. Determination of clopidogrel main metabolite in plasma: a useful tool for monitoring therapy? Ther Drug Monit. 2008;30:84–89. doi: 10.1097/FTD.0b013e31815c13fd. [DOI] [PubMed] [Google Scholar]
  • 31.Lau WC, Gurbel PA, Watkins PB. Contribution of hepatic cytochrome P450 3A4 metabolic activity to the phenomenon of clopidogrel resistance. Circulation. 2004;109:166–171. doi: 10.1161/01.CIR.0000112378.09325.F9. [DOI] [PubMed] [Google Scholar]
  • 32.Bennett JS. Novel platelet inhibitors. Annu Rev Med. 2001;52:161–184. doi: 10.1146/annurev.med.52.1.161. [DOI] [PubMed] [Google Scholar]
  • 33.Jonas S, Grieco G. An approach to estimation of the risk of TTP during clopidogrel therapy. Stroke. 2004;35:537–538. [PubMed] [Google Scholar]
  • 40.Kocabay G, Okçular I, Akkaya V, et al. Suicide attempt with clopidogrel. Hum Exp Toxicol. 2006;25:731–734. doi: 10.1177/0960327106073794. [DOI] [PubMed] [Google Scholar]
  • 41.Chawla LS, Moore G, Seneff MG. Incomplete reversal of enoxaparin toxicity by protamine: implications of renal insufficiency, obesity, and low molecular weight heparin sulfate content. Obes Surg. 2004;14:695–698. doi: 10.1381/096089204323093516. [DOI] [PubMed] [Google Scholar]
  • 42.Cherfan A, Arabi Y., Al Askar A, et al. Recombinant activated factor VII treatment of retroperitoneal hematoma in a patient with renal failure receiving enoxaparin and clopidogrel. Pharmacotherapy. 2007;27:755–759. doi: 10.1592/phco.27.5.755. [DOI] [PubMed] [Google Scholar]
  • 43.Weinsheimer RL, Libby E, Howdieshell TR. Life-threatening abdominal wall hematoma in a chronic renal failure patient after a single dose of enoxaparin. Am Surg. 2005;71:132–134. [PubMed] [Google Scholar]
  • 44.Kam PCA, Nethery CM. The thienopyridine derivatives (platelet adenosine diphosphate receptor antagonists), pharmacology and clinical developments. Anaesthesia. 2003;58:28–35. doi: 10.1046/j.1365-2044.2003.02960.x. [DOI] [PubMed] [Google Scholar]
  • 45.Levy JH, Tanaka KA. The anticoagulated patient: strategies for effective blood loss management. Surgery. 2007;142:S71–S77. doi: 10.1016/j.surg.2007.06.029. [DOI] [PubMed] [Google Scholar]
  • 46.Greer IA, McLaren M, Belch JJ, et al. Endothelial stimulation by DDAVP in von Willebrand’s disease and haemophilia. Haemostasis. 1986;16:15–19. doi: 10.1159/000215264. [DOI] [PubMed] [Google Scholar]
  • 47.Barnhart MI, Chen S, Lusher JM. DDAVP: does the drug have a direct effect on the vessel wall? Thromb Res. 1983;31:239–253. doi: 10.1016/0049-3848(83)90326-2. [DOI] [PubMed] [Google Scholar]
  • 48.Leithauser B, Zielske D, Seyfert UT, et al. Effects of desmopressin on platelet membrane glycoproteins and platelet aggregation in volunteers on clopidogrel. Clin Hemorheol Microcirc. 2008;39:293–302. [PubMed] [Google Scholar]
  • 49.Herbert JM, Bernat A, Maffrand JP. Aprotinin reduces clopidogrel-induced prolongation of the bleeding time in the rat. Thromb Res. 1993;71:433–441. doi: 10.1016/0049-3848(93)90117-7. [DOI] [PubMed] [Google Scholar]
  • 50.Bang CJ, Berstad A, Talstad I. Incomplete reversal of enoxaparin-induced bleeding by protamine sulfate. Haemostasis. 1991;21:155–160. doi: 10.1159/000216220. [DOI] [PubMed] [Google Scholar]
  • 51.Sugiyama T, Itoh M, Ohtawa M, et al. Study on neutralization of low molecular weight heparin (LHG) by protamine sulfate and its neutralization characteristics. Thromb Res. 1992;68:119–129. doi: 10.1016/0049-3848(92)90027-8. [DOI] [PubMed] [Google Scholar]
  • 52.Young G, Yonekawa KE, Nakagawa PA, et al. Recombinant activated factor VII effectively reverses the anticoagulant effects of heparin, enoxaparin, fondaparinux, argatroban, and bivalirudin ex vivo as measured using thromboelastography. Blood Coagul Fibrinolysis. 2007;18:547–553. doi: 10.1097/MBC.0b013e328201c9a9. [DOI] [PubMed] [Google Scholar]
  • 53.Bijsterveld NR, Moons AH, Boekholdt SM, et al. Ability of recombinant factor VIIa to reverse the anticoagulant effect of the pentasaccharide fondaparinux in healthy volunteers. Circulation. 2002;106:2550–2554. doi: 10.1161/01.CIR.0000038501.87442.02. [DOI] [PubMed] [Google Scholar]
  • 54.Abrams PJ, Emerson CR. Rivaroxaban: A novel, oral, direct factor Xa inhibitor. Pharmacotherapy. 2009;29:167–181. doi: 10.1592/phco.29.2.167. [DOI] [PubMed] [Google Scholar]
  • 55.Bates SM, Weitz JI. New anticoagulants: beyond heparin, low molecular weight heparin, and warfarin. Br J Pharmacol. 2005;144:1017–1028. doi: 10.1038/sj.bjp.0706153. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 56.Pradaxa [package insert]. Germany: Boehringer Ingelheim; 2008.

Articles from Journal of Medical Toxicology are provided here courtesy of Springer

RESOURCES