Warfarin overdose with a side of munchausen

Dear Sir, The article entitled, “Dying to be Ill: Munchausen meets warfarin overdose” was an illuminating and interesting read. The article evaluated a method of warfarin overdose that is not typically at the top of the list for many physicians. I commend the authors on publication of a piece that embodies several aspects of primary care in one case report. I wish to provide some added information about treatment of warfarin overdose based on severity. For minor bleeding, withholding warfarin with observation is more than enough. The treatment of warfarin overdose with severe bleeding usually begins with slow infusion of 10 mg of Vitamin K intravenously typically over the course of 20 to 60 minutes.[1] For more severe cases of bleeding, including those with an INR>2 as seen in this case report, patients should be treated with 4-factor prothrombin complex concentrate. The dosage for patients with an INR greater than 6, such as the patient in this case report is 50 units/kg.[2] When treatment has commenced, the only thing left to do is monitor patients with PT/INR at 30-minute intervals. Financial support and sponsorship Nil. Conflicts of interest There are no conflicts of interest.