Case Report
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World J Gastroenterol. Oct 14, 2013; 19(38): 6494-6499
Published online Oct 14, 2013. doi: 10.3748/wjg.v19.i38.6494
Simultaneous intrahepatic and subgaleal hemorrhage in antiphospholipid syndrome following anticoagulation therapy
In-Chul Park, Yang-Hyun Baek, Sang-Young Han, Sung-Wook Lee, Won-Tae Chung, Sung-Won Lee, Sang-Hyeon Kang, Duk-Song Cho
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
Author contributions: Park IC interpreted the data and wrote the manuscript; Baek YH reviewed the literature and edited the manuscript; Han SY, Lee SW, Kang SH and Cho DS contributed to revisions of the gastroenterology portions of the manuscript; Chung WT and Lee SW contributed to revisions of the rheumatology portions of the manuscript.
Correspondence to: Yang-Hyun Baek, MD, PhD, Assistant Professor, Division of Gastroenterology and Hepatology, Department of Internal Medicine, College of Medicine, Dong-A University, 3-1, Dongdaesin-dong, Seo-gu, Busan 602-715, South Korea. p100100@dau.ac.kr
Telephone: +82-51-2402728 Fax: +82-51-2402087
Received: July 19, 2013
Revised: August 7, 2013
Accepted: August 12, 2013
Published online: October 14, 2013
Processing time: 96 Days and 2.1 Hours
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.

Keywords: Warfarin; Liver; Subgaleal; Hemorrhage; Antiphospholipid syndrome

Core tip: An 18-year-old woman with antiphospholipid syndrome received long-term warfarin therapy for a recurrent deep vein thrombosis. Six years later, she was diagnosed with intrahepatic and subgaleal hemorrhage and received clopidogrel and hydroxychloroquine in place of warfarin. She has not developed futher recurrent thrombotic or bleeding episodes. Intrahepatic hemorrhage is a very rare complication of warfarin, and our patient experienced intrahepatic and subgaleal hemorrhages even though she did not have any risk factors for bleeding or an elevated international normalized ratio.