Warfarin-induced Mesenteric Bleeding and Small Bowel Necrosis

ABSTRACT

Oral anticoagulants are used for prophylaxis or treatment of both arterial and venous thromboembolisms, and their use has increased with the increment of the aged population and cardiovascular disease. Oral anticoagulants, such as warfarin, are associated with a risk for bleeding, but small bowel necrosis by hemorrhage is a very rare complication of warfarin therapy. The combination of warfarin and an antiplatelet agent increase the risk of bleeding. A 70-year-old man with no prior symptoms was admitted to the emergency department with periumbilical pain. He had been taking warfarin and aspirin due to valve replacement therapy. He underwent an exploratory laparotomy due to sustained abdominal pain and fever. A macroscopic examination of the resected jejunum showed transmural hemorrhagic necrosis. We report a rare case of small bowel necrosis as a complication of warfarin therapy.