phenprocoumon and Liver-Failure

Drug therapy should be individualised according to criteria of efficacy, adverse effects, and treatment adherence. This is particularly important at the interface of inpatient and ambulatory care. Aspects of drug approval (labelling) and individual refunding by health care insurances should also be taken into account.. A patient (male, 61, painter) showed elevated transaminases after treatment with phenprocoumon because of a deep vein thrombosis in 1999. Transaminases normalized completely after discontinuation of excluded. After a recurrent thrombosis in 2003 phenprocoumon was prescribed again followed by recurrent elevation of transaminases and subsequent cholestatic hepatitis progressing to fulminant hepatic failure that required liver transplantation. After transplantation the patient's general state of health was good and liver function nearly normal. Anticoagulation was indicated beyond the postoperative phase because of recurrent deep vein thrombosis and atrial fibrillation. A low molecular weight heparin was chosen for long-term treatment.. A low molecular weight heparin appears to be the most appropriate way to maintain effective and safe anticoagulation in this patient. Coumarins carry a residual risk of an extrahepatic, immunologically mediated cross sensitization. Long-term use of ximelagatran (which has been withdrawn meanwhile) may also cause liver damage. For heparinoids, hirudines, and other drugs affecting coagulation like platelet aggregation inhibitors, therapeutic evidence is not sufficient. Though subcutaneous application of heparin is a disadvantage for the patient, therapeutic alternatives do not have better documented efficacy or less hepatotoxic potential. The low molecular weight heparin fulfils the criteria for refunding set by federal jurisdiction.

Topics: Anticoagulants; Heparin, Low-Molecular-Weight; Humans; Liver Failure; Liver Transplantation; Long-Term Care; Male; Middle Aged; Phenprocoumon

Although liver damage is a relatively rare adverse effect of oral anticoagulation with phenprocoumon, acute liver failure can be a serious treatment-associated complication. In this contribution, a patient with drug-induced liver failure during oral anticoagulation with phenprocoumon is presented. This case illustrates the need for close laboratory monitoring and suggests that phenrocoumon-induced liver damage should be considered along with other common complications of this treatment.

Topics: Administration, Oral; Aged; Anticoagulants; Atrial Fibrillation; Humans; Liver Failure; Male; Phenprocoumon

Drug therapy should be individualized according to criteria of efficacy, adverse effects, and treatment adherence. This is particularly important at the interface of inpatient and ambulatory care. Aspects of drug approval (labeling) and individual refunding by health care insurance should also be taken into account.. A patient (male, 61 years, painter) showed elevated transaminases after treatment with phenprocoumon because of a deep vein thrombosis in 1999. Transaminases normalized completely after discontinuation of phenprocoumon. Other reasons for the elevated transaminases could be excluded. After a recurrent thrombosis in 2003 phenprocoumon was prescribed again followed by recurrent elevation of transaminases and subsequent cholestatic hepatitis progressing to fulminant hepatic failure that required liver transplantation. After transplantation the patient's general state of health was good and liver function nearly normal. Anticoagulation was indicated beyond the postoperative phase because of recurrent deep vein thrombosis and atrial fibrillation. A low-molecular-weight heparin was chosen for long-term treatment.. A low-molecular-weight heparin appears to be the most appropriate way to maintain effective and safe anticoagulation in this patient. Coumarins carry a residual risk of an extrahepatic, immunologically mediated cross-sensitization. Long-term use of ximelagatran may also cause liver damage. For heparinoids, hirudins, and other drugs affecting coagulation like platelet aggregation inhibitors, therapeutic evidence is not sufficient. Though subcutaneous application of heparin is a disadvantage for the patient, therapeutic alternatives do not have better documented efficacy or less hepatotoxic potential. The low-molecular-weight heparin fulfills the criteria for refunding set by federal jurisdiction.

Topics: Anticoagulants; Atrial Fibrillation; Drug Approval; Heparin, Low-Molecular-Weight; Humans; Injections, Subcutaneous; Liver Failure; Liver Function Tests; Liver Transplantation; Long-Term Care; Male; Middle Aged; Phenprocoumon; Postoperative Complications; Recurrence; Treatment Outcome; Venous Thrombosis

Acenocoumarol has been proposed repeatedly as a safe alternative drug regimen for oral anticoagulation in patients who have suffered phenprocoumon-induced fulminant hepatic failure. The current report describes 2 patients with phenprocoumon-induced hepatic failure, necessitating liver transplantation in 1 case, who showed recurrence of liver damage when oral anticoagulation with acenocoumarol was attempted. Thus, acenocoumarol may not be a safe therapeutic alternative for patients who survived severe phenprocoumon-induced hepatotoxicity.

Topics: Acenocoumarol; Anticoagulants; Female; Humans; International Normalized Ratio; Liver; Liver Failure; Liver Function Tests; Liver Transplantation; Male; Middle Aged; Phenprocoumon

A 61-year-old woman was referred because of painless jaundice, laboratory tests having indicated hepatitis with impaired liver functions. For the past two years she had been taking phenprocoumon because she had atrial fibrillation.. Serological tests largely excluded infectious, autoimmune or metabolic etiology, so that the diagnosis of drug-induced hepatic disease was made. Liver biopsy showed necrotic liver cells and mild inflammatory reaction.. A perforating duodenal ulcer required urgent surgical intervention, after which liver functions further deteriorated. The patient having refused liver transplantation she was treated symptomatically (oral vitamin K. lactulose, diuretics), phenprocoumon was discontinued and her condition slowly improved. She was discharged after two months. At subsequent examination she was symptom-free, the INR was 1.41, transaminases were normal and ultrasound merely showed a slightly inhomogeneous internal structure.. Phenprocoumon can cause liver damage even when the drug has been taken for prolonged periods without any problems. A careful history about previously administered drugs should be taken in any case of hepatitis of uncertain etiology.

Topics: Anticoagulants; Atrial Fibrillation; Chemical and Drug Induced Liver Injury; Female; Humans; Liver; Liver Failure; Liver Function Tests; Middle Aged; Phenprocoumon

Coumarin anticoagulants are known to cause hepatotoxicity, but only a few cases have been reported. Coumarins are usually administered following cardiovascular surgery and the differential diagnosis is post-transfusion hepatitis.. We report the case of a 46-year-old woman who presented with jaundice, elevated liver function tests, positive antinuclear and smooth muscle antibodies following prodromal signs of fatigue and nausea. The patient had been treated with phenprocoumon for 5 months in order to prevent thromboembolism after two strokes assumed to be due to an open foramen ovale and an aneurysmatic atrial septum.. There was no evidence of viral or other causes of hepatitis. The patient rapidly developed subacute liver failure with encephalopathy and phenprocoumon treatment was stopped. With intensive care support, as well as high-dose prednisolone treatment, she recovered. Owing to positive antinuclear and smooth muscle antibodies, the initial diagnosis 'acute autoimmune hepatitis with liver failure was made.. The lack of hypergammaglobulinaemia and the rapid recurrence of hepatitis following re-exposure to phenprocoumon led to the final diagnosis of phenprocoumon-induced idiosyncratic drug allergic hepatitis with secondary autoimmune phenomena.

Topics: Anti-Inflammatory Agents; Anticoagulants; Biopsy; Chemical and Drug Induced Liver Injury; Diagnostic Errors; Drug Hypersensitivity; Female; Heart Aneurysm; Heart Septal Defects, Atrial; Hepatitis, Autoimmune; Humans; Liver Failure; Liver Function Tests; Middle Aged; Phenprocoumon; Prednisolone; Recurrence; Stroke; Thromboembolism; Time Factors

Topics: Aged; Angina Pectoris; Chemical and Drug Induced Liver Injury; Fatal Outcome; Female; Humans; Liver Failure; Phenprocoumon