Severe poisoning with naproxen causing coagulopathy.

Bénédicte Lelièvre, Isabelle Drouillard, Chloé Thill, Gaël Le Roux, Chloé Bruneau, Julien Mahé, Marie Deguigne, David Boels

Basic & clinical pharmacology & toxicology 2020 May

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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. © 2019 Nordic Association for the Publication of BCPT (former Nordic Pharmacological Society).

Citation

Bénédicte Lelièvre, Isabelle Drouillard, Chloé Thill, Gaël Le Roux, Chloé Bruneau, Julien Mahé, Marie Deguigne, David Boels. Severe poisoning with naproxen causing coagulopathy. Basic & clinical pharmacology & toxicology. 2020 May;126(5):458-463