A Man Who Takes 26 Warfarin Pills a Day! A Case Study on Warfarin Resistance
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Abstract
In certain patients, particularly those receiving mechanical aortic valve replacement, warfarin is the sole permitted anticoagulant. Some individuals exhibit resistance to warfarin for a variety of reasons, necessitating extremely high and occasionally fatal doses of the medication for their survival. This report details a patient who demonstrates warfarin resistance and investigates the fundamental causes of this phenomenon. The case report emphasizes the possible role of genetic polymorphism in elucidating the mechanisms behind warfarin resistance.
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[2] Mostbauer H, Nishkumay O, Rokyta O, Vavryniuk VJJoIMR. Warfarin resistance: possibilities to solve this problem. A case report. J Int Med Res. 2022;50(6):03000605221103959.
[3] Xue L, Singla RK, He S, Arrasate S, González-Díaz H, Miao L, et al. Warfarin–A natural anticoagulant: A review of research trends for precision medication. Phytomedicine 2024;128:155479.
[4] Shikdar S, Vashisht R, Zubair M, Bhattacharya PT. International Normalized Ratio: Assessment, Monitoring, and Clinical Implications. 2025 Feb 14. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2025.
[5] Zhao L, Zhai Z, Li PJP, Medicine P. One rare warfarin resistance case and possible mechanism exploration. Pharmgenomics Pers Med.2023:609-15.
[6] Du X, Zhang P, Hu L, Chen Q, Cheng S, Qiu X, et al. A Chinese patient with cardiogenic stroke and warfarin resistance: a case report. BMC Neurol.2025;25(1):77.
[7] Mirzahosseini HK, Shahriari P, Yousefi-Mazhin E, Najafi A, Mojtahedzadeh A, Mojtahedzadeh MJAoA, et al. Massive Gastrointestinal Bleeding, Consequences Interactions of Apixaban, Diltiazem and Aspirin: Case Report. Arch Anesth & Crit Care. 2024; 11(2):256-258.
[8] González Della Valle A, Khakharia S, Glueck CJ, Taveras N, Wang P, Fontaine RN, et al. VKORC1 variant genotypes influence warfarin response in patients undergoing total joint arthroplasty: a pilot study. Clin Orthop Relat Res. 2009; 467(7):1773-80.
[9] Klack K, de Carvalho JFJIJoM, Frontiers B. Vitamin k: metabolism, sources and interaction with foods and oral anticoagulants. Int J Med Biol Front 2011;17(4/5):351.
[10] Elbers LP, Fliers E, Cannegieter SJJot, haemostasis. The influence of thyroid function on the coagulation system and its clinical consequences. J Thromb Haemost. 2018;16(4):634-45.
[2] Mostbauer H, Nishkumay O, Rokyta O, Vavryniuk VJJoIMR. Warfarin resistance: possibilities to solve this problem. A case report. J Int Med Res. 2022;50(6):03000605221103959.
[3] Xue L, Singla RK, He S, Arrasate S, González-Díaz H, Miao L, et al. Warfarin–A natural anticoagulant: A review of research trends for precision medication. Phytomedicine 2024;128:155479.
[4] Shikdar S, Vashisht R, Zubair M, Bhattacharya PT. International Normalized Ratio: Assessment, Monitoring, and Clinical Implications. 2025 Feb 14. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2025.
[5] Zhao L, Zhai Z, Li PJP, Medicine P. One rare warfarin resistance case and possible mechanism exploration. Pharmgenomics Pers Med.2023:609-15.
[6] Du X, Zhang P, Hu L, Chen Q, Cheng S, Qiu X, et al. A Chinese patient with cardiogenic stroke and warfarin resistance: a case report. BMC Neurol.2025;25(1):77.
[7] Mirzahosseini HK, Shahriari P, Yousefi-Mazhin E, Najafi A, Mojtahedzadeh A, Mojtahedzadeh MJAoA, et al. Massive Gastrointestinal Bleeding, Consequences Interactions of Apixaban, Diltiazem and Aspirin: Case Report. Arch Anesth & Crit Care. 2024; 11(2):256-258.
[8] González Della Valle A, Khakharia S, Glueck CJ, Taveras N, Wang P, Fontaine RN, et al. VKORC1 variant genotypes influence warfarin response in patients undergoing total joint arthroplasty: a pilot study. Clin Orthop Relat Res. 2009; 467(7):1773-80.
[9] Klack K, de Carvalho JFJIJoM, Frontiers B. Vitamin k: metabolism, sources and interaction with foods and oral anticoagulants. Int J Med Biol Front 2011;17(4/5):351.
[10] Elbers LP, Fliers E, Cannegieter SJJot, haemostasis. The influence of thyroid function on the coagulation system and its clinical consequences. J Thromb Haemost. 2018;16(4):634-45.
| Files | ||
| Issue | Article in Press |
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| Section | Case Report(s) | |
| Keywords | ||
| warfarin resistance polymorphism vitamin K antagonists | ||
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How to Cite
1.
Karballaei Mirzahosseini H, Manafi L. A Man Who Takes 26 Warfarin Pills a Day! A Case Study on Warfarin Resistance. Arch Anesth & Crit Care. 2025;.
