Abstract

WARFARIN INDUCED COAGULOPATHY ASSOCIATED WITH HEMATOMA IN RIGHT QUADRICEPS WITH BILATERAL HEMARTHROSIS: A CASE REPORT

Divya M. Laby*, Minu Mariam Jose, Jovina Merin Sam

ABSTRACT

Warfarin is now the most widely used anticoagulant and increase in its use over the last decade can provide evidence of its effectiveness in preventing embolic strokes in patients with atrial fibrillation. The main adverse effect associated with warfarin is bleeding .Major and fatal bleeding events occur respectively at rates of 7.2 and 1.3 per 100 patient-years. Here we describe a case of 72yr old female admitted with complaints of swelling in both lower limb(right>left), tenderness and discolouration on right thigh.Patient was on warfarin for atrial fibrillation since 11 months. Blood investigation showed severe anaemia and she was immediately transfused with packed red blood cells (PRBC) and fresh frozen plasma(FFP). The international normalized ratio (INR) was highly elevated and there was derangement in bleeding time and activated partial prothromplastin time. The ultrasound scan of right thigh showed hematoma and hemarthrosis. She was diagnosed with warfarin induced coagulopathy and treated Inj. Vitamin K 10mg IV once in a day for 2 days to reverse the anticoagulation effect. Warfarin was restarted at a low dose from day 4. Patient was improved and her international normalized ratio was within the normal limit upon the discharge.

Keywords: INR, warfarin, coagulopathy, vitamin k.