title: [Factitious disease caused by secret administration of the oral anticoagulant phenprocoumon: study of 16 personal cases].
abstract: BACKGROUND
  It is frequently difficult to disclose covert ingestion of cumarins being the underlying cause of a bleeding disorder.
  
  
  METHODS
  We report on 16 cases (15 patients) of phenprocoumon (Marcumar) abuse. All patients (9 females, 6 males) were admitted to the hospital because of bleeding and/or prolonged thromboplastin times. Analysis of phenprocoumon in the blood was performed by HPLC.
  
  
  CONCLUSIONS
  The clinical presentation of the bleeding was highly variable. Thromboplastin times ranged from < 5 to 58%. With the exception of two patients with hepatic dysfunctions factor V activity was normal. All but one patient denied the ingestion of Marcumar. One patient died from hemorrhage. Two types of patients emerge from our series: Type I is the young nurse (8 cases), type II the usually male patient formerly treated with phenprocoumon (5 cases). Type I patients had long medical histories and showed autoaggressive behavior including the artificial manipulation of disorders other than hemorrhage. Thromboplastin times however were within or close to the therapeutic range (10 to 25%). Type II patients did not simulate other diseases in addition to hemorrhage. Thromboplastin times were longer than in type I patients. In all instances discrimination between non suicidal and suicidal behaviour was difficult. Psychiatric consultance is indicated.
authors.affiliation: Institut für Klinische Chemie, Medizinischen Hochschule Hannover.
authors.forename: D
authors.initials: D
authors.lastname: Petersen
authors.forename: M
authors.initials: M
authors.lastname: Barthels
mesh_terms: D000284:Administration, Oral; D001780:Blood Coagulation Tests; D002851:Chromatography, High Pressure Liquid; D005260:Female; D006474:Hemorrhagic Disorders / Q000139:chemically induced* / Q000523:psychology; D006801:Humans; D008297:Male; D008875:Middle Aged; D009110:Munchausen Syndrome / Q000175:diagnosis* / Q000523:psychology; D010348:Patient Care Team; D010644:Phenprocoumon / Q000008:administration & dosage / Q000009:adverse effects* / Q000493:pharmacokinetics; D012189:Retrospective Studies
chemical_list: D010644:Phenprocoumon
vernacular_title: Die artifiziell manipulierte Krankheit durch heimliche Einnahme des oralen Antikoagulans Phenoprocoumon: Untersuchung an 16 eigenen Fällen.