title: Surreptitious use of warfarin.
abstract: The authors present the case of a 61-year-old woman who became increasingly sensitive to her warfarin. When she remained anticoagulated during a 2-month period off of warfarin a plasma analysis detected warfarin indicating she was taking the anticoagulant surreptitiously. This patient demonstrated features of factitious illness including a background of unsatisfactory childhood relationships, average intelligence, a lack of psychosis, and no obvious secondary gain. Surreptitious use of anticoagulants should be considered in all cases of unexplained hemorrhagic symptoms with low prothrombin activity.
mesh_terms: D003717:Denial, Psychological; D004342:Drug Hypersensitivity / Q000175:diagnosis; D005260:Female; D006470:Hemorrhage / Q000139:chemically induced; D006801:Humans; D008875:Middle Aged; D011517:Prothrombin Time; D019966:Substance-Related Disorders / Q000175:diagnosis / Q000523:psychology*; D014859:Warfarin / Q000097:blood
chemical_list: D014859:Warfarin