title: [Can acute renal insufficiency increase the effect of warfarin?].
abstract: The use of warfarin is complicated by its narrow therapeutic index. The risk of severe complications in the form of haemorrhage is significantly increased by an elevated degree of anticoagulation. We present a case in which a patient in stable warfarin treatment was admitted with acute renal failure and extremely high international normalized ratio (INR). No single mechanism can fully explain this. We find that it was probably caused by accumulation of active metabolites, an inhibitory factor in uraemic blood, which reduces hepatic metabolism and a genotype with an unstable metabolism of warfarin.
authors.affiliation: Langelinie 59, DK-5230 Odense M. h.madsen@dadlnet.dk
authors.forename: Bjarni
authors.initials: B
authors.lastname: Arnason
authors.forename: Jakob
authors.initials: J
authors.lastname: Matthisson
authors.forename: Hanne
authors.initials: H
authors.lastname: Madsen
mesh_terms: D058186:Acute Kidney Injury / Q000097:blood / Q000378:metabolism*; D000925:Anticoagulants / Q000009:adverse effects* / Q000097:blood / Q000378:metabolism; D001189:Aryl Hydrocarbon Hydroxylases / Q000235:genetics; D065729:Cytochrome P-450 CYP2C9; D005838:Genotype; D006801:Humans; D019934:International Normalized Ratio; D008297:Male; D008875:Middle Aged; D012307:Risk Factors; D014859:Warfarin / Q000009:adverse effects* / Q000097:blood / Q000378:metabolism
chemical_list: D000925:Anticoagulants; D014859:Warfarin; C450260:CYP2C9 protein, human; D065729:Cytochrome P-450 CYP2C9; D001189:Aryl Hydrocarbon Hydroxylases