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Warfarin-associated bleeding complication saved life.

Kenneth L McCall1, Eric J MacLaughlin

  • 1School of Pharmacy, Texas Tech University Health Sciences Center, Amarillo 79106, USA. kenneth@cortex.ama.ttuhsc.edu

Pharmacotherapy
|February 12, 2002
PubMed
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Warfarin-associated bleeding in a patient with atrial fibrillation unexpectedly revealed early-stage colon cancer. This gastrointestinal bleeding, though concerning, may have led to life-saving early diagnosis.

Area of Science:

  • Gastroenterology
  • Oncology
  • Pharmacology

Background:

  • Anticoagulant therapy, such as warfarin, is crucial for managing atrial fibrillation but carries a risk of gastrointestinal bleeding.
  • Patients on anticoagulants experiencing bleeding require thorough evaluation to rule out underlying pathologies.

Observation:

  • A 62-year-old male on warfarin presented with hematochezia, with an international normalized ratio (INR) of 1.74.
  • Despite a 5% increase in warfarin dosage, the patient's INR remained subtherapeutic (1.69), and fecal occult blood testing was positive.

Findings:

  • Colonoscopy identified a 5-cm Dukes' A adenocarcinoma.
  • The patient's warfarin-associated bleeding, typically viewed as adverse, served as a diagnostic indicator for early-stage colon cancer.

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Implications:

  • This case highlights that even minor gastrointestinal bleeding in patients on anticoagulants warrants comprehensive investigation.
  • Unmasking of malignancy through anticoagulant-related bleeding can potentially lead to improved patient outcomes through early cancer detection.