Severe poisoning with naproxen causing coagulopathy

• Published in: Basic & clinical pharmacology & toxicology Vol. 126; no. 5; pp. 458 - 463
• Main Authors: Lelièvre, Bénédicte, Drouillard, Isabelle, Thill, Chloé, Le Roux, Gaël, Bruneau, Chloé, Mahé, Julien, Deguigne, Marie, Boels, David
• Format: Journal Article
• Language: English
• Published: England Wiley Subscription Services, Inc 01-05-2020; Wiley
• Subjects: Anti-Inflammatory Agents, Non-Steroidal - poisoning; Blood Coagulation Disorders - chemically induced; Coagulation; Drug Overdose; Extubation; Female; Humans; hypocoagulopathy; Inflammation; Ingestion; Life Sciences; Medication; Metabolic disorders; Middle Aged; Naproxen; Naproxen - poisoning; Nonsteroidal anti-inflammatory drugs; Pharmaceutical sciences; Side effects; Suicide, Attempted; Thrombocytopenia; Thrombopenia; Thromboxane A2; Toxicology; naproxen; hypocoagulopathy; thrombopenia; thromboxane A2
• ISSN: 1742-7835; 1742-7843
• DOI: 10.1111/bcpt.13365

Non‐steroidal anti‐inflammatory drugs (NSAIDs) are well known for their most frequent side effects (digestive, renal and metabolic disorders) but are lesser known for other effects, such as coagulation disturbances. In this issue, we report the case of a 58‐year‐old woman who ingested 26 g of naproxen in a suicidal attempt and developed cardiovascular shock, hypocoagulability and thrombopenia. Her outcome was positive (extubation 3 days after admission [D3], correction of haemostatic disruptions on D5 and of thrombopenia on D6). Naproxen plasma concentration was at a toxic concentration of 1320 mg/L at 6 hours after drug ingestion. Only few cases of hypocoagulopathy are reported with the NSAIDs, and this is the first case that can be attributed to naproxen. A possible explanation of this phenomenon following naproxen ingestion is an inhibition of thromboxane A2, usually attributed to NSAIDs, combined with an inhibition of activation of downstream the cascade.