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Warfarin Debate

William O. Robertson, MD
Arch Pediatr Adolesc Med. 1994;148(8):882. doi:10.1001/archpedi.1994.02170080112025.
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Regarding the letter by Montanio et al,1 published in the June 1993 issue of AJDC, I would interpret the implications of their findings about acute warfarin sodium ingestion entirely differently. Rather than seeing the cup "half empty," I see it almost entirely full, since so many children have eaten single doses and their patient was the only one who had a change in laboratory values but had no clinical consequences.

With limited resources available to us, it seems to me entirely irrational to recommend the type of follow-up called for by Montanio et al; in the absence of some evidence of bleeding into the skin or elsewhere, I would see the probability of deleterious clinical outcomes as being infinitesimal. It is like seeking a triiodothyronine (T3) or thyroxine (T4) level in a case of thyroid overdose when, in fact, the probability of a positive finding is virtually


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