Abstract

CASE REPORT ON WARFARIN INDUCED HEMATURIA

*Albert Thomas, Aiswarya A. A. and Anjana Peter

Abstract

Warfarin which is a coumarin derivative belongs to the class of oral anticoagulants and is mainly indicated for the treatment of thromboembolism and systemic embolic complications associated with atrial fibrillation. Hemorrhage is the primary concern for patients on warfarin. This may be indicated by elevated international normalized ratio (INR). Bleeding can vary from minor to potentially fatal. Mainly the management strategies of bleeding includes stopping of warfarin followed by oral or intravenous vitamin K administration. Case report: An 85 year old male patient came to the general medicine department with complaints of lower abdominal pain and constipation. He had a history of coronary artery disease since 5 years. The patient was taking warfarin for past 5 years without any proper monitoring of INR. During the course of treatment the patient had the complaints of hematuria. On admission laboratory investigation reveals that patient is with elevated INR and prothrombin time (PT). As there was no other cause, the patient was diagnosed to be a case of warfarin induced hematuria with sub mucosal lesion on distal esophagus. As a part of management strategy T.Warfarin was withheld and started with inj. Vitamin K for 3 days. Conclusion: Hematuria in patients treated with warfarin is common. Prothrombin time and INR should be evaluated routinely and dose of warfarin should be adjusted accordingly to prevent over anticoagulation effect of warfarin.

Keywords: Hematuria, Warfarin, Prothrombin Time, INR.