Ocular hemorrhage due to warfarin: Five case reports

Year 2013, , 389 - 393, 05.02.2014

Sedat Koçak , Esma Erdemir Birsen Ertekin , Başar Cander , Cesareddin Dikmetaş

https://doi.org/10.5835/jecm.omu.30.05.025

Abstract

An increase in the number of patients treated with anticoagulants has given rise to complications. In present study, five cases with ocular hemorrhages treated with warfarin were presented. Three men and two women applying to emergency between September 2008 and January 2012 were presented. Of cases, one was 55, and others were 65 and over. International normalized ratio (INR) values were, in turn, as follows: 5.40 in case 1, 8.33 in case 2, no coagulation in cases 3 and 4, and 5.30 in case 5. TDP was used in four cases, but merely warfarin treatment was discontinued in one case. No complication developed, and all cases were discharged as INR returned to therapeutic levels. Patients absorbing warfarin may apply to the emergency with atypical hemorrhages, one of which is ocular type. Patients known to be treated with anticoagulants should be evaluated in detail as to clear or unclear hemorrhages. 

Keywords

Emergency medicine, International normalized ratio, Ocular hemorrhage, Warfarin

References

• Ahmed, A., Stephens, J.C., Kaus, C.A., Fay, W.P., 2008. Impact of preemptive warfarin dose reduction on anticoagulation after initiation of trimethoprim-sulfamethoxazole or levofloxacin. J. Thromb. Thrombolysis. 26, 44-48.
• Ansell, J., Hirsh, J., Dalen, J., Bussey, H., Anderson, D., Poller, L., Jacobson, A., Deykin, D., Matchar, D., 2001. Managing oral anticoagulant therapy. Chest. 119, 22-38.
• Fihn, S.D., Callahan, C.M., Martin, D.C., McDonell, M.B., Henikoff, J.G., White, R.H.,1996.The risk for and severity of bleeding complications in elderly patients treated with warfarin. The National Consortium of Anticoagulation Clinics. Ann Intern Med. 124, 970-979.
• Hirsh, J., Fuster, V., Ansell, J., Halperin, J.L., 2003. American Heart Association/American College of Cardiology Foundation Guide to Warfarin Therapy. Circulation. 107, 1692-1711.
• Hirsh, J., Guyatt, G., Albers, G.W., Harrington, R., Schünemann, H.J., 2008. Antithrombotic and thrombolytic therapy: ACCP guidelines; Executive summary: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines (8th Edition). Chest. 133, 71-109.
• Landefeld, C.S., Goldman, L., 1989. Major bleeding in outpatients treated with warfarin: incidence and prediction by factors known at the start of outpatient therapy. Am. J. Med. 87, 144-152.
• Levine, M.N., Raskob, G., Landefeld, S., Hırs J., 1995. Hemorrhagic complications of anticoagulant treatment. Chest. 108, 276-290.
• Marie, I., Bodack, O.D., 2007. A warfarin-induced subconjunctival hemorrhage. Optometry. 78, 113-118.
• Marzolini, M., Wynne, H., 2002.Should patients manage their own oral anticoagulation therapy? Rev. Clin. Gerontol. 12, 275-281.
• Schurgers, L.J., Aebert, H., Vermeer, C., Bültmann, B., Janzen, J., 2004. Oral anticoagulant treatment: Friend or foe in cardiovascular disease? Blood. 104, 3231-3232.
• Superstein, R., Gomolin, J.E., Hammouda, W., Rosenberg, A., Overbury, O., Arsenault, C., 2000. Prevalence of ocular hemorrhage in patients receiving warfarin therapy. Can. J. Ophthalmol. 35, 385-389.
• Wiedermann, C.J., Stockner, I., 2008. Warfarin-induced bleeding complications-clinical presentation and therapeutic options. Thromb. Res. 2, 13-18.