title: [Phenprocoumon-induced liver failure].
abstract: METHODS
  A 61-year-old woman was referred because of painless jaundice, laboratory tests having indicated hepatitis with impaired liver functions. For the past two years she had been taking phenprocoumon because she had atrial fibrillation.
  
  
  METHODS
  Serological tests largely excluded infectious, autoimmune or metabolic etiology, so that the diagnosis of drug-induced hepatic disease was made. Liver biopsy showed necrotic liver cells and mild inflammatory reaction.
  
  
  METHODS
  A perforating duodenal ulcer required urgent surgical intervention, after which liver functions further deteriorated. The patient having refused liver transplantation she was treated symptomatically (oral vitamin K. lactulose, diuretics), phenprocoumon was discontinued and her condition slowly improved. She was discharged after two months. At subsequent examination she was symptom-free, the INR was 1.41, transaminases were normal and ultrasound merely showed a slightly inhomogeneous internal structure.
  
  
  CONCLUSIONS
  Phenprocoumon can cause liver damage even when the drug has been taken for prolonged periods without any problems. A careful history about previously administered drugs should be taken in any case of hepatitis of uncertain etiology.
authors.affiliation: Medizinische Klinik, Fachbereich Gastroenterologie, Städtische Kliniken Esslingen/N., Akademisches Lekrankenhaus der Universität Tübingen, Esslingen.
authors.forename: A
authors.initials: A
authors.lastname: Cordes
authors.forename: W
authors.initials: W
authors.lastname: Vogt
authors.forename: H H
authors.initials: HH
authors.lastname: Dahm
authors.forename: K P
authors.initials: KP
authors.lastname: Maier
mesh_terms: D000925:Anticoagulants / Q000009:adverse effects* / Q000627:therapeutic use; D001281:Atrial Fibrillation / Q000188:drug therapy; D056486:Chemical and Drug Induced Liver Injury / Q000175:diagnosis* / Q000209:etiology; D005260:Female; D006801:Humans; D008099:Liver / Q000473:pathology; D017093:Liver Failure / Q000139:chemically induced*; D008111:Liver Function Tests; D008875:Middle Aged; D010644:Phenprocoumon / Q000009:adverse effects* / Q000627:therapeutic use
chemical_list: D000925:Anticoagulants; D010644:Phenprocoumon
vernacular_title: Phenprocoumon-induziertes Leberversagen.