BACKGROUND Warfarin, a vitamin K antagonist, is a widely used medication for the treatment and prophylaxis of thromboembolic events. Patients with various clinical conditions due to warfarin overdose present to emergency departments. Although there may be serious bleeding due to a warfarin overdose, no bleeding may also be seen in some clinical conditions. Some of these bleedings may be life-threatening and result in death. Warfarin overdose and related cases of spontaneous bladder rupture are not frequently observed in the literature. We present a case of spontaneous bladder rupture due to warfarin overdose that was unexpectedly seen in a patient using warfarin for coronary artery disease and arrhythmia. CASE PRESENTATION A 77-year-old Caucasian male patient was admitted to the emergency department with abdominal pain, haematuria, and a reduced volume of urine lasting for three days. The patient's amount of urine was reduced, and he came to the hospital for the first time with this complaint. The patient had local bruises on his arms and legs. From the ultrasound, retrograde cystography and computed tomography images, it was thought that there was blood accumulation due to bladder rupture to the intraperitoneal region. Spontaneous bladder rupture secondary to warfarin overdose was considered for this patient who also had an international normalized ratio (INR) level of 13.4. After the INR level was normalized with vitamin K and a prothrombin complex concentrate, the patient underwent surgery. During the operation, a catheter was placed in the bladder, and the bladder mucosa and muscle were closed separately with a primary repair performed by a urologist. The patient was discharged on the 8th postoperative day without any complications. CONCLUSION In addition to the known findings of warfarin overdose in these patients presenting to the emergency department, we think that the emergency department staff should suspect bladder rupture, which is a fatal complication in the presence of signs such as oliguria, haematuria, anuria, abdominal pain, and syncope.

中文翻译：

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华法林用药过量导致的自发性膀胱破裂：1例病例报告。

背景技术华法林是一种维生素K拮抗剂，是一种广泛用于治疗和预防血栓栓塞事件的药物。因华法令过量而导致各种临床情况的患者出现在急诊科。尽管由于华法林用药过量可能导致严重出血，但在某些临床情况下也未见出血。其中一些出血可能会危及生命，并导致死亡。文献中不经常观察到华法林过量和自发性膀胱破裂的相关病例。我们提出一例因服用华法令而导致冠状动脉疾病和心律不齐的患者因华法令过量而自发性膀胱破裂的病例。病例介绍一名77岁的白人男性患者因腹部疼痛，血尿，并减少了三天的尿量。病人的尿量减少了，他第一次因这种抱怨而去医院。该患者的胳膊和腿上有局部瘀伤。从超声，逆行膀胱造影和计算机断层扫描图像中，认为由于膀胱破裂至腹膜内区域而存在血液积聚。对于华法林过量服用继发自发性膀胱破裂的患者，该患者的国际标准化比率（INR）水平也为13.4。用维生素K和凝血酶原复合物浓缩液使INR水平正常后，患者接受了手术。手术期间，将导管置于膀胱中，并由泌尿科医师进行一次初步修复，分别关闭膀胱粘膜和肌肉。术后第8天出院，无任何并发症。结论除了向急诊科就诊的华法林用药过量的已知发现外，我们认为急诊科工作人员应怀疑膀胱破裂，这是在出现诸如少尿，血尿，无尿，腹部腹泻等体征的情况下的致命并发症。疼痛和晕厥。