Simultaneous intrahepatic and subgaleal hemorrhage in antiphospholipid syndrome following anticoagulation therapy

In-Chul Park; Yang-Hyun Baek; Sang-Young Han; Sung-Wook Lee; Won-Tae Chung; Sung-Won Lee; Sang-Hyeon Kang; Duk-Song Cho

doi:10.3748/wjg.v19.i38.6494

Simultaneous intrahepatic and subgaleal hemorrhage in antiphospholipid syndrome following anticoagulation therapy

World J Gastroenterol. 2013 Oct 14;19(38):6494-9. doi: 10.3748/wjg.v19.i38.6494.

Authors

In-Chul Park¹, Yang-Hyun Baek, Sang-Young Han, Sung-Wook Lee, Won-Tae Chung, Sung-Won Lee, Sang-Hyeon Kang, Duk-Song Cho

Affiliation

¹ In-Chul Park, Yang-Hyun Baek, Sang-Young Han, Sung-Wook Lee, Won-Tae Chung, Sung-Won Lee, Sang-Hyeon Kang, Duk-Song Cho, Division of Gastroenterology and Hepatology, Department of Internal Medicine, College of Medicine, Dong-A University, Busan 602-715, South Korea.

Abstract

Warfarin is a widely used anticoagulant. Interindividual differences in drug response, a narrow therapeutic range and the risk of bleeding render warfarin difficult to use clinically. An 18-year-old woman with antiphospholipid syndrome received long-term warfarin therapy for a recurrent deep vein thrombosis. Six years later, she developed right flank pain. We diagnosed intrahepatic and subgaleal hemorrhages secondary to anticoagulation therapy. After stopping oral anticoagulation, a follow-up computed tomography showed improvement in the hemorrhage. After restarting warfarin because of a recurrent thrombosis, the intrahepatic hemorrhage recurred. We decided to start clopidogrel and hydroxychloroquine instead of warfarin. The patient has not developed further recurrent thrombotic or bleeding episodes. Intrahepatic hemorrhage is a very rare complication of warfarin, and our patient experienced intrahepatic and subgaleal hemorrhage although she did not have any risk factors for bleeding or instability of the international normalized ratio control.

Keywords: Antiphospholipid syndrome; Hemorrhage; Liver; Subgaleal; Warfarin.

Publication types

Case Reports

MeSH terms

Adolescent
Anticoagulants / adverse effects*
Antiphospholipid Syndrome / blood
Antiphospholipid Syndrome / complications
Antiphospholipid Syndrome / diagnosis
Antiphospholipid Syndrome / drug therapy*
Chemical and Drug Induced Liver Injury / diagnosis
Chemical and Drug Induced Liver Injury / etiology*
Chemical and Drug Induced Liver Injury / prevention & control
Clopidogrel
Drug Substitution
Drug Therapy, Combination
Female
Flank Pain / chemically induced
Hemorrhage / chemically induced*
Hemorrhage / diagnosis
Hemorrhage / prevention & control
Humans
Hydroxychloroquine / therapeutic use
International Normalized Ratio
Magnetic Resonance Imaging
Platelet Aggregation Inhibitors / therapeutic use
Recurrence
Risk Factors
Scalp*
Skin Diseases / chemically induced*
Skin Diseases / diagnosis
Skin Diseases / prevention & control
Ticlopidine / analogs & derivatives
Ticlopidine / therapeutic use
Tomography, X-Ray Computed
Treatment Outcome
Venous Thrombosis / blood
Venous Thrombosis / diagnosis
Venous Thrombosis / drug therapy*
Venous Thrombosis / etiology

Substances

Anticoagulants
Platelet Aggregation Inhibitors
Hydroxychloroquine
Clopidogrel
Ticlopidine