• Jiahao Chen, Le Li, and Shiyu Wang.
• Department of Pharmacy, The People's Hospital of Hezhou, Hezhou, China.
• Medicine (Baltimore). 2024 Nov 22; 103 (47): e40658e40658.

RationaleWarfarin is the most commonly used drug in patients with mechanical valve replacement. Acute liver damage after warfarin is rare but potentially harmful. We present a case of warfarin-induced gastrointestinal bleeding with liver injury, pharmacy monitoring, and its therapy.Patient ConcernsA 64-year-old woman with warfarin 4.5 mg medical history 10 years after mechanical mitral valve replacement. Who presented with gastrointestinal bleeding and extensive ecchymosis, due to rising international normalized ratio (INR), and then progressed to acute liver injury.DiagnosesWarfarin poisoning.InterventionsDiscontinuing warfarin, and artificial liver support system with anti-inflammatory liver therapy, which used reduced glutathione, polyene phosphatidylcholine, and ademetionine 1,4-butanedisulfonate for injection, ursodeoxycholic acid for orally.OutcomesThe liver enzymes and hyperbilirubinemia were improved, she was placed on warfarin again, and the INR increased to 2.03. There was no significant increase in liver enzymes and hyperbilirubinemia, she was discharged on day 24.LessonsClose monitoring and immediate dose adjustment of warfarin and to avoid drug-drug interaction. Timely stopped warfarin, adjusted INR and anti-inflammatory liver therapy may reduce the occurrence of warfarin-induced liver failure.Copyright © 2024 the Author(s). Published by Wolters Kluwer Health, Inc.

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