Unexpected Problems of Antithrombotic Therapy with An Unusual Side Effect of Vitamin K Antagonists after Mitral Valve Replacement.

Benjamin Marchandot, Nathan Messas, Laurence Jesel, Annie Trinh, Marion Kibler, Antje Reydel, Patrick Ohlmann, Olivier Morel

Journal: The Journal of heart valve disease 2018;26(3):309-313

PMID: 29092116

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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.

Address: Department of Cardiology, University Hospitals of Strasbourg, Nouvel Hôpital Civil, Strasbourg, France. Electronic correspondence: [email protected].; Department of Cardiology, University Hospitals of Strasbourg, Nouvel Hôpital Civil, Strasbourg, France.

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MeSH Terms: Anticoagulants, Chemical and Drug Induced Liver Injury, Drug Substitution, Female, Fibrinolytic Agents, Heart Valve Prosthesis, Heart Valve Prosthesis Implantation, Heparin, Low-Molecular-Weight, Humans, Liver Function Tests, Middle Aged, Mitral Valve, Phenindione, Risk Factors, Treatment Outcome, Vitamin K, Warfarin