title: [Fatal intracerebral haemorrhage possibly caused by interaction between paracetamol and warfarin].
abstract: This is a case report of an 83-year-old man in warfarin treatment with stable international normalised ratio (INR) after aortic valve replacement and atrial fibrillation. Due to back pain he took paracetamol (acetaminophen) 4 g/day, morphine 30 mg/day and diclofenac as rescue medication for two weeks. After 14 days of treatment he was admitted to a hospital with acute neurological deficits, and a blood sample showed INR levels above 10. A CT-scan of the brain showed an intracerebral haemorrhage. The patient died eight days after admission. Mechanisms of the possible interaction between paracetamol and warfarin are discussed.
authors.affiliation: Klinisk Farmakologisk Afdeling, Bispebjerg Hospital, Bispebjerg Bakke 23, 2400 København NV. signe.vinsand.naver@regionh.dk.
authors.forename: Signe Vinsand
authors.initials: SV
authors.lastname: Naver
authors.forename: Maria
authors.initials: M
authors.lastname: Papina
authors.forename: Espen Jimenez
authors.initials: EJ
authors.lastname: Solem
authors.forename: Kim Peder
authors.initials: KP
authors.lastname: Dalhoff
mesh_terms: D000082:Acetaminophen / Q000008:administration & dosage / Q000009:adverse effects* / Q000494:pharmacology / Q000627:therapeutic use; D000369:Aged, 80 and over; D018712:Analgesics, Non-Narcotic / Q000008:administration & dosage / Q000009:adverse effects* / Q000494:pharmacology / Q000627:therapeutic use; D000925:Anticoagulants / Q000008:administration & dosage / Q000009:adverse effects* / Q000494:pharmacology / Q000627:therapeutic use; D002543:Cerebral Hemorrhage / Q000139:chemically induced* / Q000000981:diagnostic imaging; D004347:Drug Interactions; D017809:Fatal Outcome; D006801:Humans; D008297:Male; D014057:Tomography, X-Ray Computed; D014859:Warfarin / Q000008:administration & dosage / Q000009:adverse effects* / Q000494:pharmacology / Q000627:therapeutic use
chemical_list: D018712:Analgesics, Non-Narcotic; D000925:Anticoagulants; D000082:Acetaminophen; D014859:Warfarin