Complications of Oral Anticoagulant Therapy in over 65 Years, a Case Report

Case description: Woman, 79 years old. Medical history: hypertension, Atrial fibrillation (AF) permanent treated with acenocoumarol and mitral insufficiency. Barthel 90, Lowton-Brody. 2. The patient came to the emergency room for rib pain (musculoskeletal) in last two weeks, without other symptoms. We initiated analgesia and the patient was discharged. She came back with new symptoms: epistaxis and dyspnea. Exploration and complementary tests: cardio-pulmonary auscultation arrhythmic tones with sternal border systolic murmur left, crakling sounds in the lungs, with decreased breath sounds. Chest x-ray: right hilar mass with right pleural thickening, and diffuse bilateral infiltration. CBC: hemoglobin 7.9 g/dl (First: 11.6 g/dl), WBC 11.57x10l. Biochemistry: PCR 72.90 mg/l, urea 85 mg/l. Coagulation: INR undetermined, activity prothrombin <12.5%. Diagnosis: bilateral alveolar hemorrhage. Diagnosis Differential: bilateral alveolar hemorrhage, bilateral pneumonia, heart failure congestive (Acute Lung Edema). Conclusion: 0.5% of the population uses oral anticoagulants, between 6.8-11.1% by FA an INR>, increases the risk of bleeding. This is a patient with multimorbidity, moderately dependent, with poor treatment compliance and anticoagulation control. Given these data (anemia, no signs of infection or heart failure), and the test results, we opted for the first possibility alveolar hemorrhage diagnosed.