UNIVERSITAS AIRLANGGA



Detail Article

Jurnal Oftalmologi Indonesia

ISSN 1693-2587

Vol. 7 / No. 4 / Published : 2010-12

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Original Article :

Awareness of subconjunctival bleeding on warfarin therapy patient

Author :

  1. Diana Haryati Kusumastuti*1
  2. Dewi Rosalina*2
  3. Ratna Doemilah*3
  4. Evelyn Komaratih*4
  1. Department of Ophthalmology, Faculty of Medicine Airlangga University/Dr. Soetomo General Hospital, Surabaya

Abstract :

A case of subconjunctival bleeding as an initial sign of progressive bleeding caused by warfarin therapy on patient with mitralregurgitation, its clinical signs, multidisciplinary approach and management. A 36 years old male came to eye emergency unit with chief complaints such as subconjunctival bleeding and diplopia. He suffered from mitral regurgitation and took warfarin as oralanticoagulant during the previous month. Ophthalmology examination revealed subconjunctival bleeding and chemosis, eyelid hematoma, and proptosis on the left eye. Retinal hemorrhage (flamed shape) and vascular tortuousity were found on both eyes. Orbital CT-Scan showed retrobulbar hemorrhage on lateral side of the left orbita. Laboratory findings were International Normalized Ratio (INR) 5.36, Prothrombin Time >2.01, Activated Partial Thromboplastin Time (APTT) 124. The signs of progressive bleeding of the eye were documented. The patient was consulted to cardiology, pulmonology, and internal department. The advice given was the discontinuation of warfarin and continued with ambulatory treatment. We were aware of the progressive bleeding, and decided to hospitalize the patient. Warfarin was discontinued and vitamin K was administered intravenously. His general condition decreased, and the patient was taken to resuscitation room. Subconjunctival bleeding was the initial sign of progressive multiorgan hemorrhage causing the death of the patient 22 hours later. Massive multiorgan hemorrhage could be caused by warfarin, and subconjunctivalbleeding could be an initial sign of progressive bleeding. It is important to be aware of this sign and detailed history shouldbe taken to find underlying disease. Multidisciplinary management should be undertaken by departments such as cardiology, pulmonology, internal, and anesthesiology.

Keyword :

warfarin, subconjunctival bleeding, multi organ hemorrhage,


References :

-,(2009) Toxicity, Warfarin and Superwarfarins. eMedicine, Emergengcy Medicine - : http://emedicine.medscape.com

Kneeland PP, Fang MC,(2010) Current issues in patient adherence and persistence: focus on anticoagulants for the treatment and prevention of thromboembolism - : Patient Prefer Adherence Journal

Rosmiati H, Gan Vincent HS,(1995) Antikoagulan, Antitrombosit. Trombolitik dan Hemostatik; Farmakologi dan Terapi Edisi 4 - : Farmakologi Fakultas Kedokteran Universitas Indonesia

Kerrison JB, Iwamoto A, Merbs SL, Hiff NT,(1998) Orbital Trauma in: Management Of Ocular Injuries And Emergencies Philladelphia : Lippincot – Raven

Superstein R, Gomolin JE, HammoudaW, Rosenberg A, Overbury O, Arsenault C,(2000) Prevalence of Ocular Hemorrhage in Patients Receiving Warfarin Therapy - : Can J Ophthalmol





Archive Article

Cover Media Content

Volume : 7 / No. : 4 / Pub. : 2010-12
  1. Visual Acuity Of Methanol Intoxicated Patiens Before And After Hemodialysis, Methylprednisolone And Prednisone Therapy
  2. Cutler Beard Technique For The Management Of Superior Palpebra Sebaceous Adenocarcinoma
  3. Long-term Used Of Benzalkonium Chloridepreservative Antiglaucoma Eye Drops (studies On The Expression Of Matrix-metalloproteinase-1 And Tissue Inhibitor Matrix Metalloproteinase-1)
  4. The Profile Of Tear Mucin Layer And Impression Cytology In Pterygium Patients
  5. Constraints And Supporting Factors To Access Free Cataract Surgery
  6. Correlation Between Blood Glucose Level And Hba1 C With Lens Thickness In Type 2 Diabetes Mellitus Patients
  7. Traumatic Globe Subluxation
  8. Awareness Of Subconjunctival Bleeding On Warfarin Therapy Patient
  9. Bilateral Optic Neuritis In Children Due To Multiple Sclerosis
  10. Bilateral Optic Neuritis In Children Due To Multiple Sclerosis

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