[Liver damage in a patient treated with a vitamin K antagonist, a statin and an ACE inhibitor].
We report the case of a 71-year-old male patient who presented at the emergency room with episodes of epistaxis and jaundice. The patient was on therapy with phenprocoumon, atorvastatin and perindopril. Findings on admission included prominent elevation of transaminases and bilirubin and a high INR due to impaired liver function and oral anticoagulation. After exclusion of other causes like viral or autoimmune hepatitis and after having obtained a liver biopsy, a diagnosis of drug induced liver damage (DILI) was made. Epidemiology, pathophysiology and clinical signs of DILI are discussed with a special focus on coumarines, statins and ACE-inhibitors.
Bruggisser
M
M
Abteilung für Klinische Pharmakologie & Toxikologie und Regionales Pharmakovigilance Zentrum Basel, Universitätsspital Basel, Basel. bruggisserm@uhbs.ch
Terraciano
L
L
Rätz Bravo
A
A
Haschke
M
M
D000284:Administration, Oral; D000368:Aged; D000806:Angiotensin-Converting Enzyme Inhibitors / Q000008:administration & dosage / Q000633:toxicity*; D000925:Anticoagulants / Q000008:administration & dosage / Q000633:toxicity*; D000069059:Atorvastatin; D001706:Biopsy; D056486:Chemical and Drug Induced Liver Injury / Q000175:diagnosis / Q000209:etiology* / Q000473:pathology; D004347:Drug Interactions; D004359:Drug Therapy, Combination; D006417:Hematuria / Q000139:chemically induced / Q000473:pathology; D006538:Heptanoic Acids / Q000008:administration & dosage / Q000633:toxicity*; D006801:Humans; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors / Q000008:administration & dosage / Q000633:toxicity*; D008099:Liver / Q000187:drug effects / Q000473:pathology; D008111:Liver Function Tests; D008297:Male; D020913:Perindopril / Q000008:administration & dosage / Q000633:toxicity*; D010644:Phenprocoumon / Q000008:administration & dosage / Q000009:adverse effects*; D011758:Pyrroles / Q000008:administration & dosage / Q000633:toxicity*; D014812:Vitamin K / Q000037:antagonists & inhibitors*
D000806:Angiotensin-Converting Enzyme Inhibitors; D000925:Anticoagulants; D006538:Heptanoic Acids; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors; D011758:Pyrroles; D014812:Vitamin K; D000069059:Atorvastatin; D010644:Phenprocoumon; D020913:Perindopril