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Titolo:
An uncommon cause of severe bleeding during phenprocoumon treatment
Autore:
Neuhaus, T; Hertfelder, HJ; Hess, L; Oldenburg, J; Walger, P; Vetter, H;
Indirizzi:
Med Univ Poliklin, D-53111 Bonn, Germany Med Univ Poliklin Bonn Germany D-53111 v Poliklin, D-53111 Bonn, Germany Univ Bonn, Inst Expt Hamatol & Transfus Med, D-5300 Bonn, Germany Univ Bonn Bonn Germany D-5300 matol & Transfus Med, D-5300 Bonn, Germany
Titolo Testata:
DEUTSCHE MEDIZINISCHE WOCHENSCHRIFT
fascicolo: 25-26, volume: 126, anno: 2001,
pagine: 754 - 756
Fonte:
ISI
Lingua:
GER
Soggetto:
FACTOR-IX PROPEPTIDE; ORAL ANTICOAGULANT-THERAPY; INCREASED SENSITIVITY; MISSENSE MUTATIONS; ALA-10; WARFARIN; PATIENT;
Tipo documento:
Article
Natura:
Periodico
Settore Disciplinare:
Clinical Medicine
Life Sciences
Citazioni:
9
Recensione:
Indirizzi per estratti:
Indirizzo: Neuhaus, T Med Univ Poliklin, Wilhelmstr 35-37, D-53111 Bonn, Germany Med Univ Poliklin Wilhelmstr 35-37 Bonn Germany D-53111 ermany
Citazione:
T. Neuhaus et al., "An uncommon cause of severe bleeding during phenprocoumon treatment", DEUT MED WO, 126(25-26), 2001, pp. 754-756

Abstract

History and admission findings: A 66-year-old patient presented to our clinic with extensive left arm and left flank haematomas, anaemia, a prolongedactivated partial thromboplastin time (aPTT), and reduced factor IX activity 6 weeks after prosthetic mechanical aortic valve implantation. Investigation: Treatment with both vitamin K and a single injection of factor IX concentrate led to normalization of the activated partial thromboplastin time and factor IX activity, which remained constant for several days. No acquired factor IX inhibitor was detectable. Analysis of exon 2 of the factor IX gene revealed a C -->T mutation in codon 10 of the propeptide region, resulting in the substitution of alanine by valine. Echocardiography revealed a significant paravalvular leak. Treatment and course: The substitution of valine for alanine in the factorIX propeptide leads to an impaired affinity of factor IX to the vitamin K-carboxylase complex. In this situation, treatment with coumarin derivativescan profoundly reduce factor IX activity and result in severe bleeding episodes. This patient was re-exposed to warfarin under close hematological monitoring. After 4 days factor IX activity had decreased to 15%, which was associated with an increase of the aPTT and a mild decrease of the prothrombin time. Due to rapid progression of the paravalvular leak and almost impossible long-term orale anticoagulation with coumarin derivatives, we recommended replacement of the prosthetic mechanical valve with a biological device. Conclusion: The development of severe bleeding in the context of initiating warfarin therapy raises the suspicion of a factor IX propeptide mutation. The initial screening test is the activated partial thromboplastin time, which is elevated in the presence of the mutation. If concomitantly diminished factor IX activity is found the factor IX propeptide mutation should be excluded. Use of lifelong coumarin derivatives is contraindicated in patients with this mutation. However, a general screening of the activated partial thromboplastin time after coumarin initiation is not justified by cost/benefit analysis.

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Documento generato il 04/07/20 alle ore 14:42:17