![]() album) are used as complementary medicine in oncology. Nab-paclitaxel can displace warfarin from its albumin binding sites and increase the free and active concentration of warfarin. Then, the patient interview found out that he self-medicated with subcutaneous injections of mistletoe extracts: 10 mg on day 0 and on day 2. Based on the chronology, a drug interaction between chemotherapy and warfarin was first suspected. The final diagnosis was an anemic syndrome due to gastrointestinal bleeding secondary to VKA overdose. Warfarin was discontinued and the patient received vitamin K supplementation and transfusions. At day 5, the biological assessment revealed anemia with hemoglobinemia of 5.1 g/dL and an international normalized ratio of 7.3, indicating vitamin K antagonist (VKA) overdose. At day 3, he reported faintness and melena. He was also treated with warfarin for atrial fibrillation. A patient over 75 years of age was treated with nab-paclitaxel and gemcitabine as a first course for metastatic pancreatic adenocarcinoma (day 0). This case reports drug interactions leading to bleeding secondary to warfarin overdose. Some patients are adept at taking medicinal plants, a practice often unknown to health professionals who take care of them. Patients do not necessarily mention to their oncologist this phytotherapeutic treatment which may be responsible for unsuspected drug interactions. Mistletoe, Viscum album, is a medicinal plant used in complementary medicine in oncology.
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