Related Experiment Video
Updated: Aug 14, 2026
11:06
Human Liver Microphysiological System for Assessing Drug-Induced Liver Toxicity In Vitro
Published on: January 31, 2022
[Drug-induced liver injury (DILI)]
Manuel Zingg1, Ruth Greber1, Giacomo Faleschini2
1Stadtbachpraxis Burgdorf, Burgdorf, Schweiz.
Praxis
|August 13, 2026
Summary
Phenprocoumon treatment for sinus vein thrombosis caused recurrent bleeding and drug-induced liver injury (DILI). Switching to apixaban and vitamin K stabilized the patient, confirming phenprocoumon-induced toxic hepatitis.
Area of Science:
- Pharmacology
- Hepatology
- Hematology
Background:
- A case of recurrent international normalised ratio (INR) derailment during phenprocoumon therapy for sinus vein thrombosis.
- Patient presented with bleeding (epistaxis, hematuria, vaginal bleeding) and elevated liver enzymes.
- Hospitalization led to diagnosis of acute hepatitis secondary to drug-induced liver injury (DILI).
Purpose of the Study:
- To report a rare case of phenprocoumon-induced toxic hepatitis.
- To highlight the importance of monitoring liver function during anticoagulation therapy.
- To discuss the management of INR derailment and DILI in patients on phenprocoumon.
Main Methods:
- Clinical case presentation and management.
- Laboratory investigations including liver function tests.
- Liver biopsy for histopathological examination.
- Therapeutic intervention involving drug discontinuation, anticoagulation switch, and vitamin K administration.
Main Results:
- Phenprocoumon treatment led to recurrent INR derailment and significant bleeding.
- Diagnosis of acute hepatitis consistent with DILI was confirmed.
- Discontinuation of phenprocoumon, switch to apixaban, and vitamin K administration resulted in patient stabilization.
Conclusions:
- Phenprocoumon can cause toxic hepatitis and INR derailment.
- Close monitoring for liver injury and bleeding is crucial in patients receiving phenprocoumon.
- Alternative anticoagulants like apixaban may be considered in cases of phenprocoumon-induced hepatotoxicity.
Related Concept Videos
01:22Effect of Hepatic Disease on Pharmacokinetics: Pathophysiologic Assessment and Liver Function Test
In clinical practice, the direct measurement of hepatic blood flow to evaluate liver function presents significant challenges due to the intricate and specialized nature of the necessary techniques. Consequently, healthcare professionals often rely on empirical estimates derived from thorough patient examinations and liver function tests to gauge liver health. Among the tools at their disposal, the Child–Pugh and MELD scoring systems stand out for their ability to categorize and assess the...
01:26Effect of Hepatic Disease on Pharmacokinetics: Drug Dosing and Hepatic Blood Flow
Chronic liver disease significantly impacts drug metabolism due to alterations in hepatic blood flow and enzyme accessibility. This disruption affects the body's pharmacokinetics—the movement and processing of drugs within the system. Key enzymes crucial for metabolizing medications become less accessible, changing how drugs are processed and utilized. Furthermore, liver disease influences the synthesis of plasma proteins, such as albumin and globulins, which play critical roles in drug binding...
01:08Effect of Hepatic Disease on Pharmacokinetics: Dose Adjustments Due to Hepatic Impairment
Hepatic impairment, characterized by decreased liver function, does not uniformly mandate adjustments in drug dosage. Whether dosage modifications are necessary depends on various factors related to the drug's metabolism and elimination pathways. If a drug is primarily excreted via the kidneys and bypasses significant hepatic processing, if it undergoes minimal metabolic transformation in the liver, or if it is volatile and primarily expelled through the lungs, dose adjustments may not be...
01:24Drug Toxicity: Dose-Dependent Reactions
Drug toxicities can be stratified into pharmacological, pathological, or genotoxic based on their mechanisms. The incidence and severity of these toxicities generally increase with the drug's concentration in the body and exposure time.Pharmacological toxicity is evident when the therapeutic effects of drugs overshoot into adverse reactions in a predictable, dose-dependent manner. Central nervous system (CNS) depression from barbiturates is a classic example, with effects escalating from...
01:16Drug toxicity: Idiosyncratic Reactions
Idiosyncratic drug reactions represent abnormal chemical responses that vary significantly among individuals, ranging from extreme sensitivity to low doses to insensitivity to high doses. These reactions often occur due to the drug's covalent binding with serum proteins, forming a foreign hapten that triggers an immunotoxicological response. The variability in drug reactions has a strong pharmacogenetic foundation, with genetic differences crucial in how individuals metabolize drugs. For...
01:14Effect of Hepatic Disease on Pharmacokinetics: Active Drug, Metabolite and Fraction of Metabolized Drug
In pharmacotherapy, monitoring drug concentrations is paramount, especially for drugs whose therapeutic effects hinge on both the active compound and its metabolite. Hepatic impairment profoundly influences drug potency by altering liver function. If the drug is more potent than its metabolite, impaired liver function amplifies drug activity due to elevated drug concentration levels. Conversely, if the metabolite holds greater potency, diminished liver function diminishes drug activity by...