Awareness of Subconjunctival Bleeding on Warfarin Therapy Patient
ABSTRACT: A case of
subconjunctival bleeding as an initial sign of progressive bleeding caused by
warfarin therapy on patient with mitral regurgitation, 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 oral anticoagulant
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 wre 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 subconjunctival bleeding could be
an initial sign of progressive bleeding. It is important to be aware of this
sign and detailed history should be taken to find underlying disease.
Multidisciplinary management should be undertaken by departments such as
cardiology, pulmonology, internal, and anesthesiology.
Penulis: Diana Haryati
Kusumastuti, Dewi Rosalina, Ratna Doemilah, Evelyn Komaratih
Kode Jurnal: jpkedokterandd100038
