phenprocoumon and Vitamin-K-Deficiency

A 61-year old woman with atrial fibrillation developed macrohaematuria during anticoagulant treatment with a direct oral factor Xa inhibitor for stroke prevention. Abnormal results of coagulation assays were first interpreted as an effect of the anticoagulant. However, upon further testing diagnosis of vitamin K deficiency was established. After vitamin K supplementation, coagulation tests normalized and macrohaematuria disappeared. Treatment with broad spectrum antibiotics for urinary tract infection was finally established as a rare cause for vitamin K deficiency in the patient.

Topics: Administration, Oral; Anti-Bacterial Agents; Anticoagulants; False Positive Reactions; Female; Hematuria; Humans; Middle Aged; Phenprocoumon; Treatment Outcome; Vitamin K; Vitamin K Deficiency

We report the case of a 28-year old woman with extensive red-black colored lesions of the skin on the left thigh, which appeared without trauma. The disease arrived during longterm coumarin therapy because of a deep vein thrombosis and an antiphospholipid syndrome. After consideration of the differential diagnoses and due to the typical clinical picture we made the diagnosis of coumarin necrosis. We review the clinical and therapeutic features for this rare complication.

Topics: Adult; Anticoagulants; Antiphospholipid Syndrome; Blood Coagulation Tests; Coumarins; Diagnosis, Differential; Drug Administration Schedule; Drug Eruptions; Drug Therapy, Combination; Female; Humans; Leg Dermatoses; Long-Term Care; Necrosis; Phenprocoumon; Skin; Venous Thrombosis; Vitamin K Deficiency

Coumarin poisoning in dogs is not unusual and is in most cases caused by warfarin, a coumarin derivative which is used as a rodenticide. Competitive inhibition of vitamin K with an incomplete synthesis of the coagulation factors II, VII, IX and X can lead to a significant bleeding tendency. We observed a 3-year old male West Highland White Terrier with a reduced general condition and dyspnoea together with a massive haemothorax. Administration of vitamin K1 (3 mg/kg) led to a rapid improvement of the condition. Coagulation analysis revealed a prolonged activated recalcification time (ARCT), prothrombin time (PT) and aPTT with uncharacteristic thrombin time (TT); factor II, VII and X activities were reduced while factor V activity was normal, all of which are characteristic for coumarin poisoning. HPLC did not reveal the presence of warfarin but of phenoprocoumon, a drug used for thromboembolic prophylaxis in humans. This observation has not been described for dogs to date.

Topics: Animals; Anticoagulants; Blood Coagulation; Dog Diseases; Dogs; Male; Partial Thromboplastin Time; Phenprocoumon; Prothrombin Time; Thrombin Time; Vitamin K Deficiency

Topics: Anticoagulants; Hemoptysis; Humans; Male; Middle Aged; Phenprocoumon; Pulmonary Alveoli; Vitamin K; Vitamin K Deficiency

A 32-year-old patient died of a cerebellar haemorrhage and the blood coagulation analysis before death suggested defective synthesis of vitamin K-dependent clotting factors due to vitamin K deficiency. The post-mortem toxicological examination of different tissues revealed phenprocoumon poisoning as the cause of death. The differential diagnosis of vitamin K deficiency and the toxicology of hydroxycoumarins are discussed.

Topics: Adult; Blood Coagulation Tests; Brain; Brain Death; Cerebellar Diseases; Cerebral Hemorrhage; Dose-Response Relationship, Drug; Drug Overdose; Humans; Male; Phenprocoumon; Vitamin K Deficiency

Topics: Abdominal Pain; Aged; Drug Overdose; Female; Gastritis; Gastrointestinal Hemorrhage; Hematoma; Humans; Phenprocoumon; Self Medication; Skin Diseases; Vitamin K Deficiency

Topics: 4-Hydroxycoumarins; Animals; Blood Coagulation; Factor IX; Lung Neoplasms; Male; Mice; Mice, Inbred C57BL; Neoplasm Metastasis; Neoplasm Transplantation; Neoplasms, Experimental; Phenprocoumon; Transplantation, Isogeneic; Vitamin K Deficiency

Topics: Animals; Cycloheximide; Dactinomycin; Dicumarol; Factor V; Fructose-Bisphosphate Aldolase; Kynurenine; L-Serine Dehydratase; Liver; Male; Phenprocoumon; Prothrombin; Rats; Tryptophan Oxygenase; Vitamin K; Vitamin K Deficiency