warfarin and Arthralgia

Hemarthrosis can occur in patients with a predisposition to hemorrhage, such as hemophiliacs or patients on anticoagulation therapy. If hemarthrosis recurs after supportive treatment, however, other etiologies such as anatomical abnormalities should be considered. Spontaneous articular pseudoaneurysm associated with anticoagulation treatment has not been reported previously. We describe a patient on anticoagulation therapy with bilateral hemarthrosis due to pseudoaneurysms. After failing to respond to the correction of over-anticoagulation, magnetic resonance imaging led to the diagnosis of articular pseudoaneurysm. The patient was treated successfully by transarterial embolization.

Topics: Aged; Aneurysm, False; Anticoagulants; Arthralgia; Embolization, Therapeutic; Hemarthrosis; Humans; Knee; Magnetic Resonance Imaging; Male; Warfarin

Drug metabolism may be perturbed by genetically determined differences in the metabolic activity of cytochrome P450 enzymes. The authors encountered extensive bleeding in a patient receiving warfarin for anticoagulation after the introduction of celecoxib, an anti-inflammatory drug. As the CYP2C9 enzyme metabolises these drugs, it was determined whether variant alleles were responsible for altering warfarin handling. Genetic analysis established that the patient was a compound heterozygote with CYP2C9*2 and *3 variant alleles, which exhibit lower drug metabolising capacity and enhance susceptibility to drug toxicity.

Topics: Aged; Anti-Inflammatory Agents, Non-Steroidal; Anticoagulants; Arthralgia; Aryl Hydrocarbon Hydroxylases; Celecoxib; Cytochrome P-450 CYP2C9; Drug Interactions; Female; Hemorrhage; Humans; International Normalized Ratio; Polymorphism, Genetic; Pyrazoles; Sulfonamides; Warfarin