title: Niacin induced coagulopathy as a manifestation of occult liver injury.
abstract: Niacin is an effective lipid-lowering agent which occasionally may cause hepatic failure. Liver enzymes are periodically tested during niacin therapy to assess for hepatic injury. We report a case of suppressed synthesis of hepatically derived coagulation factors and other liver proteins in a patient on niacin with no elevation of hepatic aminotransferases. The protein abnormalities reversed rapidly on discontinuation of niacin. It appears that niacin can cause occult liver injury without frank aminotransferase elevations, and may portend severe hepatotoxicity. Periodic assessment of prothrombin time should be considered in addition to aminotransferase levels to screen for liver injury. We believe this is the first reported case of occult hepatic injury due to extended release niacin, presenting as coagulopathy.
authors: Department of Internal Medicine, West Virginia University Health Sciences Center, Charleston Division, Charleston, USA.
authors: Ehab Haj
authors: EH
authors: Ali
authors: Brittain
authors: B
authors: McJunkin
authors: Steven
authors: S
authors: Jubelirer
authors: William
authors: W
authors: Hood
mesh_terms: D001778:Blood Coagulation Disorders / Q000097:blood* / Q000209:etiology; D001779:Blood Coagulation Factors / Q000378:metabolism*; D056486:Chemical and Drug Induced Liver Injury / Q000097:blood* / Q000150:complications / Q000175:diagnosis*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009525:Niacin / Q000009:adverse effects*; D010314:Partial Thromboplastin Time; D011517:Prothrombin Time
chemical_list: D001779:Blood Coagulation Factors; D009525:Niacin