title: [Derailed oral anticoagulation with very high INR values and poor response to oral vitamin K--cholestasis as a possible cause].
abstract: A 76-year-old man under long term oral anticoagulant treatment showed unclottable prothrombin time (PT) without overt bleeding. After oral administration of vitamin K1, PT remained severely prolonged and the patient was hospitalized. INR was 8.0 and responded to parenteral vitamin K. Cholestasis resulting in poor intestinal vitamin K resorption was assumed to have caused "overanticoagulation". Quick test is a global clotting test for the extrinsic and common pathways of the coagulation system. Increased PT, i.e. decreased Quick percentage, may be due to different conditions and should--if unexplained--be further analyzed by assaying factors II, V, VII, X and fibrinogen. Preanalytical problems, plasma dilution with clotting factor-free volume replacement, decreased vitamin K-dependent clotting factors (oral anticoagulation, intoxication with certain rodenticides, vitamin K deficiency), impaired liver synthetic capacity, disseminated intravascular coagulation, or massive heparin contamination may cause prolonged PT. Newborns physiologically have longer PT and should receive vitamin K prophylaxis.
authors.affiliation: Hämatologisches Zentrallabor der Universität, Inselspital, Bern.
authors.forename: S
authors.initials: S
authors.lastname: Fontana
authors.forename: S
authors.initials: S
authors.lastname: Zeerleder
authors.forename: B
authors.initials: B
authors.lastname: Lämmle
mesh_terms: D000284:Administration, Oral; D000368:Aged; D000925:Anticoagulants / Q000008:administration & dosage / Q000009:adverse effects*; D001780:Blood Coagulation Tests; D002780:Cholestasis, Intrahepatic / Q000150:complications* / Q000175:diagnosis; D003937:Diagnosis, Differential; D019918:Heart Valve Prosthesis Implantation; D006474:Hemorrhagic Disorders / Q000175:diagnosis / Q000209:etiology*; D006801:Humans; D019934:International Normalized Ratio; D008297:Male; D010644:Phenprocoumon / Q000008:administration & dosage / Q000009:adverse effects*; D011183:Postoperative Complications / Q000175:diagnosis / Q000209:etiology*; D014812:Vitamin K / Q000008:administration & dosage
chemical_list: D000925:Anticoagulants; D014812:Vitamin K; D010644:Phenprocoumon