Reactions 1704, p372 - 2 Jun 2018 Gum bleeding: case report A 77-year-old man developed gum bleeding during treatment with warfarin. The man, who had been receiving treatment with oral warfarin 1.25mg daily for three weeks for persistent non- valvular atrial fibrillation, developed moderate gum bleeding at the INR of 3.41. Thereafter, the man’s gum bleeding was well-controlled with warfarin discontinuation. The man then started receiving oral warfarin 1.25mg daily for prevention of stroke or systemic embolism during next admission. However, he developed serious gum bleeding again at the INR of 3.05. Subsequently, his warfarin therapy was discontinued, and he was started on phytomenadione. One hour later, the gum bleeding improved and INR value also decreased to 2.07. A genetic analysis for warfarin revealed the presence of reduced-function alleles of VKORC1 (AA) and CYP2C9 (*1/*3). Based on this analysis, he was considered to be warfarin-sensitive. He was then treated with left atrial appendage closure and rivaroxaban. Author comment: "A 77-year-old persistent [non-valvular atrial fibrillation] male. . .who had been taking warfarin with the dosage of 1.25mg daily for 3 weeks, suffered from a moderate gum bleeding at the presence of international normalized ratio (INR) being 3.41 outside the hospital." "Meanwhile, when regarding a high risk of stroke (CHA2DS2-VASc score of 2) and intolerance to OAC of the present patient, LAAC was regarded as a preferable option on the basis of patient’s aspiration." Shen L, et al. Optimal nonvitamin K antagonist oral anticoagulant therapy in a warfarin-sensitive patient after left atrial appendage closure: A case report. Medicine 97: e0683, No. 18, 01 May 2018. Available from: URL: http:// doi.org/10.1097/MD.0000000000010683 - China 803322742 0114-9954/18/1704-0001/$14.95 Adis © 2018 Springer International Publishing AG. All rights reserved Reactions 2 Jun 2018 No. 1704
Reactions Weekly – Springer Journals
Published: Jun 2, 2018
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