Association of marked prolongation of prothrombin time-international normalized ratio with warfarin and endoscopic nasobiliary drainage for biliary fistula after left hemihepatectomy.

Abstract

WHAT IS KNOWN AND OBJECTIVE:

Vitamin K deficiency is known to cause impaired coagulation. We report a case of marked prolongation of the prothrombin time-international normalized ratio (PT-INR) associated with warfarin and vitamin K deficiency caused by endoscopic nasobiliary drainage (ENBD).

CASE PRESENTATION:

Oral administration of warfarin was initiated in a 67-year-old man after left hemihepatectomy. He developed a biliary fistula after surgery that was treated by ENBD, which resulted in significant prolongation of the PT-INR.

WHAT IS NEW AND CONCLUSION:

The effect of warfarin was enhanced in this patient due to reduced absorption of vitamin K as a result of external biliary drainage.

• Authors: Takafumi Nakazawa, Shingo Yamazaki, Masashi Uchida, Takaaki Suzuki, Takako Nakamura, Tsukasa Takayashiki, Masayuki Ohtsuka, Itsuko Ishii
• Journal: Journal of clinical pharmacy and therapeutics (J Clin Pharm Ther) Vol. 45 Issue 4 Pg. 815-818 (Aug 2020) ISSN: 1365-2710 [Electronic] England
• PMID: 32208539 (Publication Type: Case Reports)
• Copyright: © 2020 John Wiley & Sons Ltd.

Chemical References

• Warfarin

Topics

• Aged
• Biliary Fistula (therapy)
• Drainage (adverse effects)
• Drug Interactions
• Endoscopy
• Hepatectomy (adverse effects)
• Humans
• International Normalized Ratio
• Male
• Prothrombin Time
• Vitamin K Deficiency (complications)
• Warfarin (adverse effects)