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Liver damage induced by coumarin anticoagulants
S Ehrenforth1, J F Schenk, I Scharrer
1Department of Internal Medicine, University Hospital, Frankfurt a.M., Germany.
Seminars in Thrombosis and Hemostasis
|May 18, 1999
Summary
Coumarin anticoagulants, like phenprocoumon and warfarin, can cause rare but severe drug-induced liver injury (DILI). This case highlights the importance of recognizing coumarin-induced hepatitis, even when symptoms mimic viral hepatitis.
Area of Science:
- Hepatology
- Clinical Pharmacology
- Internal Medicine
Background:
- Coumarin anticoagulants are widely used for preventing thromboembolic events.
- Adverse effects are generally rare, with bleeding being the most common.
- Hepatotoxicity is an uncommon but serious adverse reaction.
Observation:
- A 56-year-old woman experienced recurrent severe hepatitis after exposure to phenprocoumon and warfarin.
- The liver dysfunction showed a temporal relationship with drug re-exposure.
- Symptoms improved upon drug discontinuation and recurred upon re-challenge.
Findings:
- The patient's presentation was consistent with coumarin-induced hepatitis.
- Liver histology supported the diagnosis of drug-induced liver injury.
- Alternative anticoagulation with heparin and acenocoumarol led to clinical improvement.
Implications:
- Clinicians should consider coumarin-induced hepatitis in patients with unexplained liver dysfunction.
- Awareness of this rare hepatotoxic potential is crucial for patient safety.
- Prompt recognition and drug withdrawal are key to managing coumarin-induced liver injury.