A Case of Soft Tissue Bleeding Due to a Possible Drug Interaction between Warfarin and TS-1.
10.5045/kjh.2005.40.4.271
- Author:
Jae Min CHUN
1
;
Nam Sook PARK
;
Nam Hwan PARK
;
Gak Won YUN
;
Young Joon YANG
;
Hwan Jung YUN
;
Deog Yeon JO
;
Samyong KIM
Author Information
1. Department of Internal Medicine, College of Medicine, Chungnam National University, Daejeon, Korea. frkim@cnuh.co.kr
- Publication Type:Case Report
- Keywords:
Warfarin;
TS-1;
Prothrombin time
- MeSH:
Buttocks;
Classification;
Colonic Neoplasms;
Drug Interactions*;
Drug Therapy;
Emergency Service, Hospital;
Female;
Fluorouracil;
Follow-Up Studies;
Hematoma;
Hematuria;
Hemorrhage*;
Hepatectomy;
Humans;
International Normalized Ratio;
Leucovorin;
Liver;
Lung;
Plasma;
Prothrombin Time;
Thigh;
Thrombosis;
Tomography, X-Ray Computed;
Veins;
Vena Cava, Inferior;
Vitamin K;
Warfarin*
- From:Korean Journal of Hematology
2005;40(4):271-273
- CountryRepublic of Korea
- Language:Korean
-
Abstract:
Warfarin is one of the most commonly used oral anticoagulant. It is well established that a wide range of drugs, including the anticancer drug 5-fluorouracil, interact with warfarin; this results in altered coagulation parameters and bleeding sequelae. To date, any drug interaction between warfarin and TS-1 has not been reported on. A 58-yr old woman visited emergency department with gross hematuria and soft tissue swelling involving her left thigh and buttock. She had been diagnosed as having advanced colon cancer (Duke's classification D); she had undergone right hemicolectomy and partial hepatectomy, and she had received 5-FU/leucovorin chemotherapy two years prior to admission. Recurrent disease was revealed in the liver and lungs, and so 6 cycles of FOLFIRI (5-FU, leucovorin and irinotecan) chemotherapy were given. Follow-up abdominal CT scan showed progressive disease and then TS-1 oral chemotherapy was started. She took warfarin 2mg per day because of partial thrombosis in the lower inferior vena cava and left ovarian vein. The initial laboratory tests revealed a prothrombin time of 120 seconds and an international normalized ratio of 35. Fresh frozen plasma and a parenteral vitamin K injection were given. After resorption of the subcutaneous hematoma, warfarin was restarted at a dose of 1mg per day. This case shows the significant increased bleeding tendency following the combined administration of warfarin and TS-1. Because of the potential severity of this interaction, close monitoring of the coagulation parameters is recommended for patients receiving warfarin together with TS-1.
