Abstract
Except for bleeding complications, vitamin K antagonists (VKAs) are known to have few undesirable side effects. Herein is presented the case of a 45-year-old woman in whom liver damage was induced by fluindione and warfarin after mitral valve replacement. Hepatotoxicity is a rare complication of VKAs, both in the French National and Drug Safety registry and the medical literature. A diagnosis of VKA-induced drug damage was confirmed by the absence of other etiologies, the chronological sequence, recurrence after re-exposure to VKA, and rapid improvements after discontinuation of the drug. Despite possible cross-reactions between VKAs, the re-introduction of acenocoumarol was successfully achieved, with no recurrence of biological disturbances.
MeSH terms
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Anticoagulants / administration & dosage
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Anticoagulants / adverse effects*
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Chemical and Drug Induced Liver Injury / diagnosis
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Chemical and Drug Induced Liver Injury / etiology*
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Chemical and Drug Induced Liver Injury / therapy
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Drug Substitution
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Female
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Fibrinolytic Agents / administration & dosage
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Fibrinolytic Agents / adverse effects*
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Heart Valve Prosthesis
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Heart Valve Prosthesis Implantation* / adverse effects
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Heart Valve Prosthesis Implantation* / instrumentation
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Heparin, Low-Molecular-Weight / administration & dosage
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Humans
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Liver Function Tests
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Middle Aged
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Mitral Valve / diagnostic imaging
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Mitral Valve / physiopathology
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Mitral Valve / surgery*
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Phenindione / administration & dosage
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Phenindione / adverse effects
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Phenindione / analogs & derivatives*
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Risk Factors
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Treatment Outcome
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Vitamin K / antagonists & inhibitors*
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Warfarin / administration & dosage
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Warfarin / adverse effects*
Substances
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Anticoagulants
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Fibrinolytic Agents
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Heparin, Low-Molecular-Weight
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Vitamin K
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Phenindione
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Warfarin
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fluindione