{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,4]],"date-time":"2026-05-04T16:27:07Z","timestamp":1777912027831,"version":"3.51.4"},"reference-count":10,"publisher":"Walter de Gruyter GmbH","issue":"1","license":[{"start":{"date-parts":[[2026,1,26]],"date-time":"2026-01-26T00:00:00Z","timestamp":1769385600000},"content-version":"unspecified","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2026,4,30]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec id=\"j_dmpt-2025-0062_abs_001\">\n                    <jats:title>Objectives<\/jats:title>\n                    <jats:p>Warfarin resistance represents a rare yet clinically significant challenge, especially among patients with mechanical heart valves. It may result from either hereditary or acquired factors.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"j_dmpt-2025-0062_abs_002\">\n                    <jats:title>Case presentation<\/jats:title>\n                    <jats:p>A 27-year-old male patient with a history of aortic and mitral valve replacement was followed with subtherapeutic International Normalized Ratio (INR) of 1.8\u20132.0 despite receiving 20\u202fmg\/day of warfarin. He was hospitalized for evaluation, and potential acquired causes of warfarin resistance were excluded. The patient was discharged with a plan for close INR monitoring. Following the initiation of lorazepam and olanzapine for a comorbid psychiatric condition, he re-presented with bleeding manifestations due to warfarin overdose. Notably, his apparent warfarin resistance resolved after the addition of these medications, and he has since been maintained within the therapeutic INR range on a stable warfarin dose of 5\u202fmg\/day.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"j_dmpt-2025-0062_abs_003\">\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Warfarin is known to interact with numerous medications, and new drug interactions continue to be reported in the literature. Although no major interactions with lorazepam or olanzapine have been previously documented, in this case the concomitant initiation of these agents appeared to overcome warfarin resistance. This clinical course was remarkable for the apparent resolution of warfarin resistance, raising the possibility of underlying pharmacologic interactions.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1515\/dmpt-2025-0062","type":"journal-article","created":{"date-parts":[[2026,1,23]],"date-time":"2026-01-23T19:40:34Z","timestamp":1769197234000},"page":"51-53","source":"Crossref","is-referenced-by-count":0,"title":["From warfarin resistance to warfarin overdose: an unusual case report"],"prefix":"10.1515","volume":"41","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-8407-3909","authenticated-orcid":false,"given":"Mehmet U\u011fur","family":"\u00c7al\u0131\u015fkan","sequence":"first","affiliation":[{"name":"Department of Cardiology , Kizilcahamam State Hospital, Ankara , T\u00fcrkiye"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"374","published-online":{"date-parts":[[2026,1,26]]},"reference":[{"key":"2026050115412483184_j_dmpt-2025-0062_ref_001","doi-asserted-by":"crossref","unstructured":"Olie, RH, Winckers, K, Rocca, B, Ten Cate, H. Oral anticoagulants beyond warfarin. Annu Rev Pharmacol Toxicol 2024;64:551\u201375. https:\/\/doi.org\/10.1146\/annurev-pharmtox-032823-122811.","DOI":"10.1146\/annurev-pharmtox-032823-122811"},{"key":"2026050115412483184_j_dmpt-2025-0062_ref_002","doi-asserted-by":"crossref","unstructured":"Connolly, SJ, Karthikeyan, G, Ntsekhe, M, Haileamlak, A, Sayed, AE, Ghamrawy, AE, et al.. Rivaroxaban in rheumatic heart disease\u2013associated atrial fibrillation. N\u00a0Engl J Med 2022;387:978\u201388. https:\/\/doi.org\/10.1056\/nejmoa2209051.","DOI":"10.1056\/NEJMc2213437"},{"key":"2026050115412483184_j_dmpt-2025-0062_ref_003","doi-asserted-by":"crossref","unstructured":"Malik, J, Ishaq, U, Javed, N, Baig, MA, Javaid, M. Genetic warfarin-resistance resulting in surgery to change a prosthetic valve. Eur J Case Rep Intern Med 2020;7:001851. https:\/\/doi.org\/10.12890\/2020_001851.","DOI":"10.12890\/2020_001851"},{"key":"2026050115412483184_j_dmpt-2025-0062_ref_004","doi-asserted-by":"crossref","unstructured":"Azzam, H, Elwakeel, H, Awad, I, El-Farahaty, R, El-Gilany, AH, El-Sharawy, S. VKORC1 and CYP2C9 genotypes in Egyptian patients\u00a0with\u00a0warfarin resistance. Blood Coagul Fibrinolysis 2016;27:121\u20136. https:\/\/doi.org\/10.1097\/mbc.0000000000000168.","DOI":"10.1097\/MBC.0000000000000168"},{"key":"2026050115412483184_j_dmpt-2025-0062_ref_005","doi-asserted-by":"crossref","unstructured":"Wang, M, Zeraatkar, D, Obeda, M, Lee, M, Garcia, C, Nguyen, L, et al.. Drug-drug interactions with warfarin: a systematic review and meta-analysis. Br J Clin Pharmacol 2021;87:4051\u2013100. https:\/\/doi.org\/10.1111\/bcp.14833.","DOI":"10.1111\/bcp.14833"},{"key":"2026050115412483184_j_dmpt-2025-0062_ref_006","doi-asserted-by":"crossref","unstructured":"Favaedi, M, Pasebani, Y, Kabiri, A, Rafati, A, Jalali, S, Kiani, A, et al.. A case of unexplained warfarin resistance: a case report and literature review. J\u00a0Tehran Heart Cent 2023;18:302\u20136. https:\/\/doi.org\/10.18502\/jthc.v18i4.14831.","DOI":"10.18502\/jthc.v18i4.14831"},{"key":"2026050115412483184_j_dmpt-2025-0062_ref_007","doi-asserted-by":"crossref","unstructured":"Mostbauer, H, Nishkumay, O, Rokyta, O, Vavryniuk, V. Warfarin resistance: possibilities to solve this problem. A case report. J\u00a0Int Med Res 2022;50:3000605221103959. https:\/\/doi.org\/10.1177\/03000605221103959.","DOI":"10.1177\/03000605221103959"},{"key":"2026050115412483184_j_dmpt-2025-0062_ref_008","doi-asserted-by":"crossref","unstructured":"Juurlink, DN. Drug interactions with warfarin: what clinicians need to know. Can Med Assoc J 2007;177:369\u201371. https:\/\/doi.org\/10.1503\/cmaj.070946.","DOI":"10.1503\/cmaj.070946"},{"key":"2026050115412483184_j_dmpt-2025-0062_ref_009","doi-asserted-by":"crossref","unstructured":"Mar, PL, Gopinathannair, R, Gengler, BE, Chung, MK, Perez, A, Dukes, J, et al.. Drug interactions affecting oral anticoagulant use. Circ Arrhythm Electrophysiol 2022;15:e007956. https:\/\/doi.org\/10.1161\/circep.121.007956.","DOI":"10.1161\/CIRCEP.121.007956"},{"key":"2026050115412483184_j_dmpt-2025-0062_ref_010","doi-asserted-by":"crossref","unstructured":"Zubiaur, P, Soria-Chacartegui, P, Villapalos-Garc\u00eda, G, Gordillo-Perdomo, JJ, Abad-Santos, F. The pharmacogenetics of treatment with olanzapine. Pharmacogenomics 2021;22:939\u201358. https:\/\/doi.org\/10.2217\/pgs-2021-0051.","DOI":"10.2217\/pgs-2021-0051"}],"container-title":["Drug Metabolism and Personalized Therapy"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.degruyterbrill.com\/document\/doi\/10.1515\/dmpt-2025-0062\/xml","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/www.degruyterbrill.com\/document\/doi\/10.1515\/dmpt-2025-0062\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,5,1]],"date-time":"2026-05-01T15:42:21Z","timestamp":1777650141000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.degruyterbrill.com\/document\/doi\/10.1515\/dmpt-2025-0062\/html"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,1,26]]},"references-count":10,"journal-issue":{"issue":"1","published-online":{"date-parts":[[2026,2,26]]},"published-print":{"date-parts":[[2026,4,30]]}},"alternative-id":["10.1515\/dmpt-2025-0062"],"URL":"https:\/\/doi.org\/10.1515\/dmpt-2025-0062","relation":{},"ISSN":["2363-8915"],"issn-type":[{"value":"2363-8915","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,1,26]]}}}