Postsurgical hemorrhage resulting from a drug-induced circulating anticoagulant: report of case

A case of circulating anticoagulant resulting in persistent postoperative bleeding has been reported. All clotting factors were normal when the patient's plasma was tested in a high dilution. Unlike previous reports of this type of coagulation inhibitor, the hemorrhagic diathesis was clinically severe in comparison with the mildly abnormal in vitro tests. Many unknowns remain: the chemical nature of this anticoagulant; the time needed to return to normal coagulation levels; the frequency and severity of drug-induced anticoagulation; and the dose and duration of usage of medications resulting in circulating anticoagulants. In retrospect, the only clinical evidence suggestive of a coagulation problem in this case was a marginally elevated partial thromboplastin time. In our opinion, a preoperative coagulation screening, consisting of prothrombin time, partial thromboplastin time, platelet count, and template bleeding time, may help to prevent serious postoperative hemostatic complications.