Abstract
Except for bleeding complications, relevant adverse effects of coumarin anticoagulants
are comparatively rare considering the widespread use of these substances. Here we
present the case of a 56-year old woman who developed recurrent episodes of severe
hepatitis following repeated exposure to phenprocoumon (Marcumar®; Roche, Grenzach-Wyhlen,
Germany) and warfarin (Coumadin®; DuPont Pharma, Bad Homburg, Germany) after replacement
of the mitral valve with a mechanical prosthesis. The diagnosis of “coumarin-induced
hepatitis” is compatible with the time relationship between start of the drug and
the on set of hepatopathy (first episode 8 months, second episode 4 weeks, and third
episode 7 days), the rapid improvement following discontinuation of the drug, recurrence
of liver dysfunction after re-exposure to the drug, and liver histology. After anticoagulant
therapy was changed to heparin and acenocoumarol (Sintrom®; Ciba-Geigy, Basel, Switzerland),
the patient's general state was markedly improved and her liver values became almost
normal. This case will be discussed and compared with other reports of coumarin-induced
hepatic lesions. Although liver damage induced by coumarin derivates is rare, it is
important to be aware of the hepatotoxic potential of these drugs, which, in most
cases, mimics the clinical presentation of viral hepatitis.
Keywords:
Coumarin anticoagulants - drug-induced hepatopathy - hepatotoxic adverse effects
