A warfarin-induced subconjunctival hemorrhage

Letter to the Editor

A 60-year old man hyphema in right eye and pre-sented with hemoptysis to emergency department. The patient’s medical history was remarkable for COPD and pulmonary hypertension (PHT). Detailed history his current medications have been included warfarin treatment for PHT one month ago. His physi-cal examination was found bilateral roncus and sub-conjunctival hemorrhage (Figure 1). The relevant lab-oratory findings on admis-sion were; hemoglobin: 15.9 g/dL, hematocrit: 55 %, plt: 211.000 /mm3, leukocyte: 18.400 /mm3 and erythro-cyte sedimentation rate: 66 mm/h. Serum chemistry, re-nal and liver functions were normal. We found urinalysis analysis 200 erythrocyte in every area. In the chest ra-diograph, there was right hilar and cardio-thoracic enlargement (Figure 2). The patient’s prothrombin time (PT) was 194 (range, 22-40) and International Normalized Ratio (INR) was 27(0-1). We stopped warfarin medication and enjected two ampules IM K vitamin. In the eye consultation fundus and visual examination was normal bilaterally. Diffuse sub-conjunctival hemorrhage was observed in the rigth eye. To the patients didn’t recommend any medica-tion by the eye department. Bleeding parametres, including PT, INR and hemogram was followed daily. The patient’s blood parametres was normal in pursuit. Subsequently, subconjunctival hemorrhage spontaneous resolved in the patient.Warfarin, one of the coumarin anticoagulants, in the most often prescribed oral anticoagulant.It’s used after treatment for pulmonary embolism, prosthetic heart valves, atrial fibrillation, and acute myocardial infarction, stroke and PHT. In pa-tients treated with war-farin, the median annual rate of major bleeding ranges from 0.9% to 2.7 %, and the rate of fa-tal bleeding range from 0.07% to 0.7 %. On the other hand, subconjunc-tival hemorrhage asso-ciated with warfarin is reported rarely.¹ No local medical or surgical treatment is generally re-quired for subconjuntival bleeding.² In conclusion, must be used warfarin treatment carefuly and laboratory results should be repeated in a short time period.

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