Anticoagulants and Transaminase Elevation

  title={Anticoagulants and Transaminase Elevation},
  author={Nipun Arora and Samuel Zachary Goldhaber},
Case 1: Mr F., a 65-year-old man with hypertension and atrial fibrillation, began long-term anticoagulation with warfarin 1 year ago. He presented with a 1-week history of nausea, anorexia, jaundice, and altered mental status. His laboratory workup showed elevated serum transaminases and direct bilirubin. Could warfarin be potentially responsible? Case 2: Mr S., a 75-year-old man with diabetes and coronary artery disease, presented with an acute anterior myocardial infarction. Echocardiography… 
A case of warfarin-induced hepatitis
A 66-year-old man admitted to the hospital presenting with dyspnea and hypoxemia was diagnosed with warfarin-induced hepatitis, and contrast-enhanced computed tomography showed massive intraluminal filling defects in both pulmonary arteries.
Hepatotoxicity With Elevated Bilirubin Secondary to Prophylactic Doses of Unfractionated Heparin: A Case Report and Review of Heparin-Induced Hepatotoxicity
  • M. Bosco, Troy D Kish
  • Medicine, Biology
    The Journal of pharmacy technology : jPT : official publication of the Association of Pharmacy Technicians
  • 2019
Hemparin-induced hepatotoxicity may occur more rapidly than previously described, and even with the use of prophylactic doses of UFH, which is important for clinicians to consider heparins in their differential as a potential cause of hepatot toxicity especially in patients without underlying hepatic disease.
Association Between Nonvitamin K Antagonist Oral Anticoagulants or Warfarin and Liver Injury: A Cohort Study.
Among patients with AF, NOACs as a group, and dabigatran alone were associated with a significantly lower risk of laboratory-based liver injury when compared with warfarin, however, liver injury occurs more frequently in real-world practice than in NOAC randomized controlled trials.
Use of apixaban after development of suspected rivaroxaban-induced hepatic steatosis; a case report
A 67-year-old male with atrial fibrillation receiving rivaroxaban who developed a 16-fold elevation in alanine transaminase, a nearly two-fold Elevation in total bilirubin, and ultrasound confirmed hepatic steatosis was switched from rivroxaban to apixaban with subsequent rapid resolution of laboratory abnormalities.
Enoxaparin-induced hepatotoxicity: clinical cases and literature review
Low molecular weight heparins, in particular enoxaparin, have a wide range of applications, including prevention and treatment of deep vein thrombosis, but a clinician should be aware of another less common but not less important adverse effect such as an elevated transaminase level.
Enoxaparin-induced hepatotoxicity: an under-recognised complication of enoxaparin therapy
A case of enoxaparin-induced hepatotoxicity in a 57-year-old man who was started on the drug for a DVT and discontinued after 6 days is described.
The Effects of Heparins on the Liver: Application of Mechanistic Serum Biomarkers in a Randomized Study in Healthy Volunteers
It is concluded that heparins as a class cause self‐limited and mild hepatocyte necrosis with secondary activation of an innate immune response.
Ascites management by cell-free concentrated ascites reinfusion therapy during recovery from drug-induced acute liver injury: a case report
Cell-free concentrated ascites reinfusion therapy is an apheresis therapy in which ascites are collected aseptically by paracentesis, concentrated, and then reinfused intravenously to preserve nutrition by reusing the fluid.
Effects of Bivalirudin and Unfractionated Heparin on Liver and Renal Function in Chinese Patients with Coronary Artery Disease Undergoing Coronary Angiography with/without Percutaneous Coronary Intervention
The effects of bivalirudin and UFH on liver/renal function in patients with coronary artery disease who underwent CAG, with or without PCI are compared.


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Phenprocoumon can cause liver damage even when the drug has been taken for prolonged periods without any problems, so a careful history about previously administered drugs should be taken in any case of hepatitis of uncertain etiology.
Liver damage induced by coumarin anticoagulants.
Although liver damage induced by coumarin derivates is rare, it is important to be aware of the hepatotoxic potential of these drugs, which, in most cases, mimics the clinical presentation of viral hepatitis.
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Two patients' characteristics--age and sex--were associated with the development of heparin-induced abnormal alanine transaminase concentrations, and the younger male patients showed a greater frequency of he Paratin-induced ALAT elevation, however, this association was not observed with the heparIn-induced ASAT increase.
Idiosyncratic drug allergic phenprocoumon-induced hepatitis with subacute liver failure initially misdiagnosed as autoimmune hepatitis.
The lack of hypergammaglobulinaemia and the rapid recurrence of hepatitis following re-exposure to phenprocoumon led to the final diagnosis of phen Procoumon-induced idiosyncratic drug allergic hepatitis with secondary autoimmune phenomena.
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A case was presented of a 51-year-old woman who underwent aortic valve replacement with a St. Jude Medical prosthesis two and a half years before who gradually developed jaundice and had to be replaced with a Carpentier bovine pericardial valve.
Elevation of Hepatic Transaminases after Enoxaparin Use: Case Report and Review of Unfractionated and Low‐Molecular‐Weight Heparin‐Induced Hepatotoxicity
The distinctive characteristics of LMWHs have resulted in decreased rates of bleeding and equivalent rates of thrombocytopenia compared with unfractionated heparin, and may have led clinicians to believe that LM WHs have lower frequencies of all common side effects.
Subacute Liver Failure Induced by Phenprocoumon Treatment
A 39-year-old woman suffering from deep venous thrombosis due to a heterozygous factor-V-Leiden mutation with resistance to activated protein C with phenprocoumon-induced liver failure requires orthotopic liver transplantation.
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Treatment with ximelagatran has been associated with mainly asymptomatic elevation of ALT levels in a mean of 7.9% of patients in the long-term clinical trial programme and nearly all of the cases occurred within the first 6 months of therapy.