title: Massive ovarian haemorrhage complicating oral anticoagulation in the antiphospholipid syndrome: a report of three cases.
abstract: We report three cases of severe haemorrhagic rupture of luteal ovarian cyst requiring surgical haemostasis in young women treated with long-term oral anticoagulation for antiphospholipid syndrome (APS) who used no contraception. At the time of bleeding, the international normalized ratios were 3.78, 4.24, and 7.11. Anticoagulation was resumed post-operatively, in association with antigonadotropic progestins to induce ovulatory suppression. A systematic use of these progestins should probably be discussed in young women receiving long-term warfarin for APS. Ovarian haemorrhage must be considered when such patients develop acute abdominal pain.
authors.affiliation: Service de Médecine Interne, Groupe Hospitalier Pitié-Salpêtrière, Paris, France.
authors.forename: E
authors.initials: E
authors.lastname: Crétel
authors.forename: P
authors.initials: P
authors.lastname: Cacoub
authors.forename: D L
authors.initials: DL
authors.lastname: Huong
authors.forename: A
authors.initials: A
authors.lastname: Gompel
authors.forename: Z
authors.initials: Z
authors.lastname: Amoura
authors.forename: J C
authors.initials: JC
authors.lastname: Piette
mesh_terms: D000284:Administration, Oral; D000293:Adolescent; D000328:Adult; D000925:Anticoagulants / Q000008:administration & dosage / Q000009:adverse effects*; D016736:Antiphospholipid Syndrome / Q000188:drug therapy*; D005260:Female; D006470:Hemorrhage / Q000139:chemically induced*; D006801:Humans; D010048:Ovarian Cysts / Q000139:chemically induced* / Q000473:pathology; D010630:Phenindione / Q000008:administration & dosage / Q000009:adverse effects / Q000031:analogs & derivatives*; D012421:Rupture; D014859:Warfarin / Q000008:administration & dosage / Q000009:adverse effects*
chemical_list: D000925:Anticoagulants; D010630:Phenindione; D014859:Warfarin; C017673:fluindione