title: Delayed subcapsular hematoma after percutaneous liver biopsy as a manifestation of warfarin toxicity.
abstract: Guidelines for the management of patients receiving chronic anticoagulation therapy who require liver biopsy are not clearly defined. In patients with normal coagulation, liver biopsy is a relatively safe procedure with a morbidity of less than 0.1% and a mortality of less than 0.01%. We report a patient with a prosthetic aortic valve who developed a large subcapsular hematoma 12 days after a percutaneous liver biopsy as a consequence of warfarin toxicity. Based on the experience with this patient, reinstitution of anticoagulant therapy should be avoided for at least 72 h after a percutaneous liver biopsy. Intravenous heparin should be resumed first, and warfarin added if no bleeding has occurred after an additional 48-72 h. The prothrombin time should be maintained at 1.5 times the baseline.
authors.affiliation: Department of Medicine, Overton Brooks Veterans Administration Medical Center, Shreveport, Louisiana.
authors.forename: D A
authors.initials: DA
authors.lastname: Scott
authors.forename: C V
authors.initials: CV
authors.lastname: Netchvolodoff
authors.forename: B R
authors.initials: BR
authors.lastname: Bacon
mesh_terms: D001707:Biopsy, Needle / Q000009:adverse effects*; D006528:Carcinoma, Hepatocellular / Q000175:diagnosis / Q000556:secondary; D056486:Chemical and Drug Induced Liver Injury; D006406:Hematoma / Q000139:chemically induced / Q000209:etiology*; D006801:Humans; D008107:Liver Diseases / Q000209:etiology*; D008113:Liver Neoplasms / Q000175:diagnosis / Q000556:secondary; D008297:Male; D008875:Middle Aged; D011517:Prothrombin Time; D013997:Time Factors; D014859:Warfarin / Q000009:adverse effects*
chemical_list: D014859:Warfarin