title: Probable interaction between warfarin and antitumor agents used in R-ESHAP chemotherapy.
abstract: BACKGROUND
  The pharmacologic effects of warfarin might be altered by various factors, including drug-drug interaction.
  
  
  METHODS
  A 49-year-old Japanese man (height, 174 cm; weight, 68 kg) presented with a 20-month history of malignant lymphoma (diffuse large B cell lymphoma, clinical stage IV). He was treated with a combination of rituximab chemotherapy and etoposide, cisplatin, high-dose cytarabine, and methyl-prednisolone (R-ESHAP). He had been receiving warfarin for the secondary prevention of pulmonary embolism with deep venous thrombosis. When R-ESHAP was started, international normalized ratio (INR) increased from 1 to 5. This phenomenon was observed again in the second R-ESHAP. The INR was increased from 2.44 to 4.71 during chemotherapy but was returned to within the normal range (1.05; normal range: 0.81-1.009) 5 days after chemotherapy was completed.
  
  
  CONCLUSIONS
  In this patient, R-ESHAP chemotherapy might have affected warfarin anticoagulation sensitivity; thus, careful monitoring of INR is essential, particularly in patients receiving warfarin who undergo R-ESHAP chemotherapy.
authors.affiliation: Division of Pharmacy, Chiba University Hospital, Department of Clinical Cell Biology, Chiba University Graduate School of Medicine, Chiba, Japan.
authors.forename: Takaaki
authors.initials: T
authors.lastname: Suzuki
authors.forename: Hitomi
authors.initials: H
authors.lastname: Koga
authors.forename: Shingo
authors.initials: S
authors.lastname: Yamazaki
authors.forename: Hiromi
authors.initials: H
authors.lastname: Saeki
authors.forename: Hiroaki
authors.initials: H
authors.lastname: Tanaka
authors.forename: Miki
authors.initials: M
authors.lastname: Nishimura
authors.forename: Chiaki
authors.initials: C
authors.lastname: Nakaseko
authors.forename: Hiromitsu
authors.initials: H
authors.lastname: Nakasa
authors.forename: Hiroyoshi
authors.initials: H
authors.lastname: Nakamura
authors.forename: Noritaka
authors.initials: N
authors.lastname: Ariyoshi
authors.forename: Mitsukazu
authors.initials: M
authors.lastname: Kitada
mesh_terms: D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use*; D002945:Cisplatin / Q000627:therapeutic use; D003561:Cytarabine / Q000627:therapeutic use; D004347:Drug Interactions; D005047:Etoposide / Q000627:therapeutic use; D005500:Follow-Up Studies; D006801:Humans; D016403:Lymphoma, Large B-Cell, Diffuse / Q000150:complications / Q000188:drug therapy*; D008297:Male; D008775:Methylprednisolone / Q000627:therapeutic use; D008875:Middle Aged; D011655:Pulmonary Embolism / Q000209:etiology / Q000517:prevention & control; D020246:Venous Thrombosis / Q000150:complications / Q000188:drug therapy*; D014859:Warfarin / Q000627:therapeutic use*
chemical_list: D003561:Cytarabine; D014859:Warfarin; D005047:Etoposide; D002945:Cisplatin; D008775:Methylprednisolone