title: Simultaneous intrahepatic and subgaleal hemorrhage in antiphospholipid syndrome following anticoagulation therapy.
abstract: Warfarin is a widely used anticoagulant. Interindividual differences in drug response, a narrow therapeutic range and the risk of bleeding render warfarin difficult to use clinically. An 18-year-old woman with antiphospholipid syndrome received long-term warfarin therapy for a recurrent deep vein thrombosis. Six years later, she developed right flank pain. We diagnosed intrahepatic and subgaleal hemorrhages secondary to anticoagulation therapy. After stopping oral anticoagulation, a follow-up computed tomography showed improvement in the hemorrhage. After restarting warfarin because of a recurrent thrombosis, the intrahepatic hemorrhage recurred. We decided to start clopidogrel and hydroxychloroquine instead of warfarin. The patient has not developed further recurrent thrombotic or bleeding episodes. Intrahepatic hemorrhage is a very rare complication of warfarin, and our patient experienced intrahepatic and subgaleal hemorrhage although she did not have any risk factors for bleeding or instability of the international normalized ratio control.
authors.affiliation: In-Chul Park, Yang-Hyun Baek, Sang-Young Han, Sung-Wook Lee, Won-Tae Chung, Sung-Won Lee, Sang-Hyeon Kang, Duk-Song Cho, Division of Gastroenterology and Hepatology, Department of Internal Medicine, College of Medicine, Dong-A University, Busan 602-715, South Korea.
authors.forename: In-Chul
authors.initials: IC
authors.lastname: Park
authors.forename: Yang-Hyun
authors.initials: YH
authors.lastname: Baek
authors.forename: Sang-Young
authors.initials: SY
authors.lastname: Han
authors.forename: Sung-Wook
authors.initials: SW
authors.lastname: Lee
authors.forename: Won-Tae
authors.initials: WT
authors.lastname: Chung
authors.forename: Sung-Won
authors.initials: SW
authors.lastname: Lee
authors.forename: Sang-Hyeon
authors.initials: SH
authors.lastname: Kang
authors.forename: Duk-Song
authors.initials: DS
authors.lastname: Cho
mesh_terms: D000293:Adolescent; D000925:Anticoagulants / Q000009:adverse effects*; D016736:Antiphospholipid Syndrome / Q000097:blood / Q000150:complications / Q000175:diagnosis / Q000188:drug therapy*; D056486:Chemical and Drug Induced Liver Injury / Q000175:diagnosis / Q000209:etiology* / Q000517:prevention & control; D000077144:Clopidogrel; D057915:Drug Substitution; D004359:Drug Therapy, Combination; D005260:Female; D021501:Flank Pain / Q000139:chemically induced; D006470:Hemorrhage / Q000139:chemically induced* / Q000175:diagnosis / Q000517:prevention & control; D006801:Humans; D006886:Hydroxychloroquine / Q000627:therapeutic use; D019934:International Normalized Ratio; D008279:Magnetic Resonance Imaging; D010975:Platelet Aggregation Inhibitors / Q000627:therapeutic use; D012008:Recurrence; D012307:Risk Factors; D012535:Scalp; D012871:Skin Diseases / Q000139:chemically induced* / Q000175:diagnosis / Q000517:prevention & control; D013988:Ticlopidine / Q000031:analogs & derivatives / Q000627:therapeutic use; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome; D020246:Venous Thrombosis / Q000097:blood / Q000175:diagnosis / Q000188:drug therapy* / Q000209:etiology
chemical_list: D000925:Anticoagulants; D010975:Platelet Aggregation Inhibitors; D006886:Hydroxychloroquine; D000077144:Clopidogrel; D013988:Ticlopidine
keywords: Antiphospholipid syndrome; Hemorrhage; Liver; Subgaleal; Warfarin