acenocoumarol and Hemoperitoneum

A 66-year-old man with a metallic valve and under treatment with acenocoumarol developed hypovolemic shock after rupture of a splenic artery pseudoaneurysm. We managed to reverse anticoagulation within 60 minutes by administering 20 mg of vitamin K and 4.8 mg of activated recombinant factor VII. No thromboembolic adverse events were observed. We discuss the pharmacologic effects of coumarin derivatives and their antagonists, as well as the use of activated factor VII in the reversal of anticoagulation by these drugs.

Topics: Acenocoumarol; Aged; Aneurysm, False; Anticoagulants; Combined Modality Therapy; Crystalloid Solutions; Drug Therapy, Combination; Embolization, Therapeutic; Erythrocyte Transfusion; Factor VIIa; Heart Valve Prosthesis; Hemoperitoneum; Humans; Isotonic Solutions; Male; Recombinant Proteins; Rupture, Spontaneous; Splenic Artery; Vitamin K 1

The haemoperitoneum and bowel haematoma are complications of the oral anticoagulant treatment. The abdominal pain in patient under oral anticoagulant drugs represents a diagnostic problem; apart of the acute abdomen, we also have to consider unusual haemorrhagic lesion, rare in patients without coagulation problems. The early diagnosis of the complication in the patients permits a conservative treatment with excellent prognosis, instead of performing surgical operations in subjects with frequent comorbidities. We report a case of haemoperitoneum and intramural bowel haematoma in a patient with altered laboratory parameters and haemodynamic instability that required an urgent surgical procedure.

Topics: Acenocoumarol; Aged; Angina Pectoris; Anticoagulants; Hematoma; Hemoperitoneum; Humans; Jejunal Diseases; Male; Treatment Outcome