Wednesday June 4, 2008


Case: 58 year old female admitted to ICU with exacerbation of Asthma. Patient is on coumadin 5 mg per day due to previous DVT, which was continued in ICU. INR on admission was therapeutic with 2.6. Patient was intubated and started on IV steroid along with antibiotic (Ceftriazone) and other home meds. Standard ICU protocols for GI prophylaxis with esomeprazole, blood sugar control, enteral nutrion and head of bed elevation were also initiated. progressively INR continues to rise and on 6th ICU day, GI bleed developed. Which medicine may have interacted with coumadin to increase INR and subsequently GI bleed?


Answer: Esomeprazole (proton pump inhibitor)

Concomitant use of warfarin (coumadin) and esomeprazole therapy may increases INR, and supratherapeutic prothrombin time may lead to abnormal bleeding and even death. Patients treated with proton pump inhibitors and warfarin concomitantly may need to be monitored for increases in INR and prothrombin time.


References: click to get abstract/article

1. Nexium - Rxlist.com