Anticoagulant-induced intramural intestinal hemorrhage

Tseng, Chia-Ying; Fan, Ju-Sing; Yang, Shu-Chuan; Huang, Hsien-Hao; Chen, Jen-Dar; Yen, David Hung-Tsang; Huang, Chun-I

doi:10.1016/j.ajem.2009.08.002

« Previous Next »American Journal of Emergency Medicine
Volume 28, Issue 8 , Pages 937-940, October 2010

Anticoagulant-induced intramural intestinal hemorrhage

Chia-Ying Tseng, MD
- Emergency Department, China Medical University Hospital, Taiwan 40447
- Emergency Medicine, College of Medicine, National Yang-Ming University, Taiwan 11221
Ju-Sing Fan, MD
- Emergency Medicine, College of Medicine, National Yang-Ming University, Taiwan 11221
- Department of Emergency Medicine, Taipei-Veterans General Hospital, Taiwan 11217
- Institute of Emergency and Critical Care Medicine, College of Medicine, National Yang-Ming University, Taiwan 11221
Shu-Chuan Yang, RN
- Department of Emergency Medicine, Taipei-Veterans General Hospital, Taiwan 11217
Hsien-Hao Huang, MD
- Emergency Medicine, College of Medicine, National Yang-Ming University, Taiwan 11221
- Department of Emergency Medicine, Taipei-Veterans General Hospital, Taiwan 11217
- Institute of Emergency and Critical Care Medicine, College of Medicine, National Yang-Ming University, Taiwan 11221
- Corresponding author. Department of Emergency Medicine, Taipei Veterans General Hospital, Taipei, Taiwan, R.O.C. Tel.: +886 2 8757628; fax: +886 2 8757842.
Jen-Dar Chen, MD
- Department of Radiology, Taipei-Veterans General Hospital, Taiwan 11217
David Hung-Tsang Yen, MD, PhD
- Emergency Medicine, College of Medicine, National Yang-Ming University, Taiwan 11221
- Department of Emergency Medicine, Taipei-Veterans General Hospital, Taiwan 11217
- Institute of Emergency and Critical Care Medicine, College of Medicine, National Yang-Ming University, Taiwan 11221
Chun-I Huang, MD
- Emergency Medicine, College of Medicine, National Yang-Ming University, Taiwan 11221
- Department of Emergency Medicine, Taipei-Veterans General Hospital, Taiwan 11217

Received 24 May 2009; received in revised form 31 July 2009; accepted 3 August 2009. published online 10 March 2010.

Abstract

Background

Long-term use of warfarin can provide benefits in the treatment of many diseases, but adverse bleeding events are unpreventable because of a narrow therapeutic range.

Objective

The aim of this retrospective chart review with data abstraction was to investigate the clinical presentations of intestinal intramural hemorrhage in emergency department (ED) patients.

Methods

We reviewed the cases of 17 patients with acute abdominal pain in our ED. Medical records including demographic data and results of abdominal computed tomography were retrospectively reviewed and analyzed.

Results

The mean ± SD age of the reviewed patients was 77.7 ± 8.5 years (range, 60-93 years). The mean ± SD duration from onset of symptoms to ED visit was 2.5 ± 1.3 days (range, 1-5 days). All patients had abdominal pain, and 64.7% had nausea/vomiting. A total of 64.7% of patients had peritoneal signs. The jejunum was most commonly involved (88.2% of all cases). The maximal mean ± SD wall thickening of the bowel was 14.1 ± 4.4 mm (range, 7.4-26.7 mm), and the estimated mean ± SD length was 35.6 ± 24.4 cm (range, 9-105 cm). The mean ± SD prothrombin time and activated partial thromboplastin time were prolonged to 86.5 ± 26.9 and 116.2 ± 43.1 seconds, respectively. All patients received medical treatment and survived. At the last follow-up (mean, 27.4 months), none of the patients had recurrence of intestinal intramural hemorrhage or intestinal obstruction.

Conclusion

Prolonged prothrombin time and drug history can indicate the possibility of intramural intestinal hemorrhage, and abdominal computed tomography may help to exclude surgical diseases and prevent unnecessary surgery.