Bleeding and Elevated INR Secondary to Concomitant Tramadol and Warfarin Administration

摘要

INTRODUCTION Tramadol is a centrally active oral synthetic analgesic indicated for the management of moderate to severe pain. Tramadol and its major active metabolite (Ml) bind to u-opiate receptors in the central nervous system (CNS), causing the inhibition of ascending pain pathways; this alters the perception of and response to pain while weakly inhibiting the reuptake of norepinephrine and serotonin, neurotransmitters that are involved in the descending inhibitory pain pathway.