An unusual case of asymptomatic diffuse alveolar hemorrhage related to amiodarone induced INR elevation
An unusual case of asymptomatic diffuse alveolar hemorrhage related to amiodarone induced INR elevation
Pulmonary adverse effects of amiodarone are an important cause of morbidi-ty. Such effects may rarely manifest as diffuse alveolar hemorrhage. Another important amiodarone-induced adverse effect is hepatotoxicity. Hepatotoxicity mostly presents as asymptomatic elevation of liver enzymes. To the best of our knowledge, in amiodarone-induced hepatotoxicity, AST and ALT elevation is well known; however, there are no clear data regarding high International Nor-malized Ratio (INR) levels in such a condition. In the present report, we describe the case of a patient under management with chronic low-dose amiodarone, who was admitted to the emergency department for lingual hematoma. During the assessment for bleeding diathesis, the INR was found to be 8.59. After exclud-ing all other possible causes for the high INR level, amiodarone was suggested to be the cause. Since there were diffuse infiltrations on chest x-ray, the patient underwent thorax tomography. Asymptomatic diffuse alveolar hemorrhage sec-ondary to INR elevation was considered. This patient is the first case who had amiodarone-induced INR elevation, and as a consequence, developed asymp-tomatic diffuse alveolar hemorrhage.
Keywords:
Amiodarone toxicity, diffuse alveolar hemorrhage, Elevated international normalized ratio,
___
- Adverse effects of amiodarone: even after the end of treatment. (2006). Prescrire Int, 15(82), 62. Cengiz Sahutoglu, Z. P., Seden Kocabas, Fatma Zekiye Askar,Aslı Hepkarsı, Cağatay Engin. (2013). Anaesthetic Management in a Heart Transplantation Patient with Amiodarone Associated Thyrotoxicosis. Journal of The Society of Thoracic Cardio-Vascular Anaesthesia and Intensive Care, 19(4), 206-210. doi:10.5222/GKDAD.2013.206Goldschlager, N., Epstein, A. E., Naccarelli, G. V., Olshansky, B., Singh, B., Collard, H. R., . . . Electrophysiology. (2007). A practical guide for clinicians who treat patients with amiodarone: 2007. Heart Rhythm, 4(9), 1250-1259. doi:10.1016/j.hrthm.2007.07.020Holm, J., Lindh, J. D., Andersson, M. L., & Mannheimer, B. (2017). The effect of amiodarone on warfarin anticoagulation: a register-based nationwide cohort study involving the Swedish population. J Thromb Haemost, 15(3), 446-453. doi:10.1111/jth.13614Lu, Y., Won, K. A., Nelson, B. J., Qi, D., Rausch, D. J., & Asinger, R. W. (2008). Characteristics of the amiodarone-warfarin interaction during long-term follow-up. Am J Health Syst Pharm, 65(10), 947-952. doi:10.2146/ajhp060415Podrid, P. J. (1995). Amiodarone: reevaluation of an old drug. Ann Intern Med, 122(9), 689-700. Qin, D., Leef, G., Alam, M. B., Rattan, R., Munir, M. B., Patel, D., . . . Saba, S. (2015). Mortality risk of long-term amiodarone therapy for atrial fibrillation patients without structural heart disease. Cardiol J, 22(6), 622-629. doi:10.5603/CJ.a2015.0055
- Yayın Aralığı: Yılda 4 Sayı
- Başlangıç: 1980
- Yayıncı: Ondokuz mayıs Üniversitesi Tıp Fakültesi