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Surreptitious use of warfarin
The Journal of Nervous and Mental Disease
|July 1, 1979
Summary
A patient secretly took warfarin, leading to unexplained bleeding. This case highlights the importance of considering surreptitious anticoagulant use in patients with low prothrombin activity and bleeding symptoms.
Area of Science:
- Internal Medicine
- Hematology
- Psychiatry
Background:
- Warfarin is a common anticoagulant used to prevent blood clots.
- Unexplained bleeding or prolonged anticoagulation can indicate non-adherence or surreptitious use.
Observation:
- A 61-year-old woman presented with increasing sensitivity to warfarin.
- Despite stopping warfarin, she remained anticoagulated, with plasma analysis confirming surreptitious warfarin intake.
- The patient exhibited characteristics of factitious illness without psychosis or obvious secondary gain.
Findings:
- Plasma warfarin detection confirmed surreptitious anticoagulant use.
- The patient's presentation suggests a factitious disorder.
Implications:
- Surreptitious anticoagulant use should be considered in unexplained hemorrhagic symptoms and low prothrombin activity.
- This case underscores the complexity of diagnosing factitious disorders involving medication misuse.