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.
MeSH terms
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Acetaminophen / administration & dosage
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Acetaminophen / adverse effects*
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Acetaminophen / pharmacology
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Acetaminophen / therapeutic use
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Aged, 80 and over
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Analgesics, Non-Narcotic / administration & dosage
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Analgesics, Non-Narcotic / adverse effects*
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Analgesics, Non-Narcotic / pharmacology
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Analgesics, Non-Narcotic / therapeutic use
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Anticoagulants / administration & dosage
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Anticoagulants / adverse effects*
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Anticoagulants / pharmacology
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Anticoagulants / therapeutic use
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Cerebral Hemorrhage / chemically induced*
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Cerebral Hemorrhage / diagnostic imaging
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Drug Interactions
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Fatal Outcome
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Humans
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Male
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Tomography, X-Ray Computed
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Warfarin / administration & dosage
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Warfarin / adverse effects*
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Warfarin / pharmacology
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Warfarin / therapeutic use
Substances
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Analgesics, Non-Narcotic
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Anticoagulants
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Acetaminophen
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Warfarin