Warfarin is an oral anticoagulant, used routinely for patients with atrial fibrillation, deep vein thrombosis, pulmonary embolism and those with a mechanical prosthetic valve. There are several noted adverse reactions associated with its use, in particular the risk of haemorrhage. Other adverse reactions include: hypersensitivity, rash, alopecia, diarrhoea, unexplained drop in haematocrit, purple toes, skin necrosis, jaundice, hepatic dysfunction, nausea, vomiting and pancreatitis. In this case report, an interesting potential adverse reaction to warfarin is discussed. The reaction described affected the patient's tongue, without affecting any other aspect of the oral cavity or body.
Clinical Relevance: This case report highlights the potential problems that can be encountered by patients on warfarin therapy, specifically, the possibility for hypersensitivity type reactions.
Article
Warfarin is an oral anticoagulant used commonly in the general population. Its mode of action is to antagonize the effect of vitamin K and inhibit coagulation. It commonly takes 48–72 hours for the anticoagulant effect to develop fully and is the drug of choice for those patients with deep vein thrombosis, pulmonary embolism, atrial fibrilliation or for patients with a mechanical prosthetic valve.1
The main adverse effect associated with warfarin is the risk of haemorrhage, therefore International Normalized Ratio (INR) levels should be checked regularly and the warfarin dose adjusted accordingly.2 Other side-effects previously noted with warfarin include:
Warfarin is well known to interact with a wide array of medications, including antibiotics and antifungals, and its action can also be affected by diet, in particular foods high in vitamin K, such as liver, broccoli and green leafy vegetables. Alcohol and periods of illness, especially bacterial or viral infections, can also affect the body's response to warfarin, thereby interfering with the INR level.3 Patients should be adequately counselled before commencing warfarin therapy with regards to diet and lifestyle, and practitioners should be vigilant when prescribing other medications for such patients.
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