warfarin and Lymphoma--Large-B-Cell--Diffuse

The pharmacologic effects of warfarin might be altered by various factors, including drug-drug interaction.. A 49-year-old Japanese man (height, 174 cm; weight, 68 kg) presented with a 20-month history of malignant lymphoma (diffuse large B cell lymphoma, clinical stage IV). He was treated with a combination of rituximab chemotherapy and etoposide, cisplatin, high-dose cytarabine, and methyl-prednisolone (R-ESHAP). He had been receiving warfarin for the secondary prevention of pulmonary embolism with deep venous thrombosis. When R-ESHAP was started, international normalized ratio (INR) increased from 1 to 5. This phenomenon was observed again in the second R-ESHAP. The INR was increased from 2.44 to 4.71 during chemotherapy but was returned to within the normal range (1.05; normal range: 0.81-1.009) 5 days after chemotherapy was completed.. In this patient, R-ESHAP chemotherapy might have affected warfarin anticoagulation sensitivity; thus, careful monitoring of INR is essential, particularly in patients receiving warfarin who undergo R-ESHAP chemotherapy.

Topics: Antineoplastic Combined Chemotherapy Protocols; Cisplatin; Cytarabine; Drug Interactions; Etoposide; Follow-Up Studies; Humans; Lymphoma, Large B-Cell, Diffuse; Male; Methylprednisolone; Middle Aged; Pulmonary Embolism; Venous Thrombosis; Warfarin

Episodic cerebro or retinovascular ischemic events without apparent cause occur in patients with cancer. We report a patient in remission from lymphoma whose multiple episodes of presumed ocular ischemia occurred in the setting of a circulating lupus anticoagulant. Symptoms resolved following therapy with Warfarin.

Topics: Antineoplastic Combined Chemotherapy Protocols; Bleomycin; Brain; Cyclophosphamide; Dexamethasone; Doxorubicin; Humans; Hypertension; Ischemic Attack, Transient; Lupus Coagulation Inhibitor; Lymphoma, Large B-Cell, Diffuse; Magnetic Resonance Imaging; Male; Middle Aged; Remission Induction; Scotoma; Vincristine; Vision, Monocular; Warfarin

Episodic cerebro or retinovascular ischemic events without apparent cause occur in patients with cancer. We report a patient in remission from lymphoma whose multiple episodes of presumed ocular ischemia occurred in the setting of a circulating lupus anticoagulant. Symptoms resolved following therapy with Warfarin.

Topics: Antineoplastic Combined Chemotherapy Protocols; Eye; Humans; Ischemia; Lupus Coagulation Inhibitor; Lymphoma, Large B-Cell, Diffuse; Male; Middle Aged; Scotoma; Vision, Monocular; Warfarin