Acute major gastrointestinal bleeding caused by hookworm infection in a patient on warfarin therapy: A case report
The use of anticoagulants is a contributor to gastrointestinal (GI) bleeding. Most bleeding patients on anticoagulant therapy such as warfarin commonly have basic lesions existing in their GI mucosa. We report a case of major GI bleeding following the use of anticoagulants in a patient with hookworm...
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| Published in | Medicine (Baltimore) Vol. 97; no. 11; p. e9975 |
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| Main Authors | , , , , |
| Format | Journal Article |
| Language | English |
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The Authors. Published by Wolters Kluwer Health, Inc. All rights reserved
01.03.2018
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| Abstract | The use of anticoagulants is a contributor to gastrointestinal (GI) bleeding. Most bleeding patients on anticoagulant therapy such as warfarin commonly have basic lesions existing in their GI mucosa.
We report a case of major GI bleeding following the use of anticoagulants in a patient with hookworm infection.
The patient was diagnosed with nephrotic syndrome with pulmonary embolism.
He was treated with anticoagulants and suffered from acute major GI bleeding during the treatment. Capsule endoscopy revealed many hookworms in the lumen of jejunum where fresh blood was seen coming from the mucosa.
The patient was successfully rescued and cured with albendazole.
Latent hookworm infection can be a cause of massive small-bowel hemorrhage in patients on anticoagulant therapy and anthelmintic treatment is the key to stop bleeding. |
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| AbstractList | The use of anticoagulants is a contributor to gastrointestinal (GI) bleeding. Most bleeding patients on anticoagulant therapy such as warfarin commonly have basic lesions existing in their GI mucosa.
We report a case of major GI bleeding following the use of anticoagulants in a patient with hookworm infection.
The patient was diagnosed with nephrotic syndrome with pulmonary embolism.
He was treated with anticoagulants and suffered from acute major GI bleeding during the treatment. Capsule endoscopy revealed many hookworms in the lumen of jejunum where fresh blood was seen coming from the mucosa.
The patient was successfully rescued and cured with albendazole.
Latent hookworm infection can be a cause of massive small-bowel hemorrhage in patients on anticoagulant therapy and anthelmintic treatment is the key to stop bleeding. The use of anticoagulants is a contributor to gastrointestinal (GI) bleeding. Most bleeding patients on anticoagulant therapy such as warfarin commonly have basic lesions existing in their GI mucosa.RATIONALEThe use of anticoagulants is a contributor to gastrointestinal (GI) bleeding. Most bleeding patients on anticoagulant therapy such as warfarin commonly have basic lesions existing in their GI mucosa.We report a case of major GI bleeding following the use of anticoagulants in a patient with hookworm infection.PATIENT CONCERNSWe report a case of major GI bleeding following the use of anticoagulants in a patient with hookworm infection.The patient was diagnosed with nephrotic syndrome with pulmonary embolism.DIAGNOSESThe patient was diagnosed with nephrotic syndrome with pulmonary embolism.He was treated with anticoagulants and suffered from acute major GI bleeding during the treatment. Capsule endoscopy revealed many hookworms in the lumen of jejunum where fresh blood was seen coming from the mucosa.INTERVENTIONSHe was treated with anticoagulants and suffered from acute major GI bleeding during the treatment. Capsule endoscopy revealed many hookworms in the lumen of jejunum where fresh blood was seen coming from the mucosa.The patient was successfully rescued and cured with albendazole.OUTCOMESThe patient was successfully rescued and cured with albendazole.Latent hookworm infection can be a cause of massive small-bowel hemorrhage in patients on anticoagulant therapy and anthelmintic treatment is the key to stop bleeding.LESSONSLatent hookworm infection can be a cause of massive small-bowel hemorrhage in patients on anticoagulant therapy and anthelmintic treatment is the key to stop bleeding. |
| Author | Lu, FangGen Shi, Lin Cheng, MeiChu Zhang, Jie Meng, Yu |
| AuthorAffiliation | Department of Gastroenterology Department of Nephrology, 2nd Xiangya Hospital of Central South University, Changsha, Hunan Province, China |
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| Cites_doi | 10.1111/j.1365-2036.2006.02784.x 10.1111/j.1572-0241.2006.00969.x 10.4269/ajtmh.1966.15.1032 10.1038/ajg.2015.246 10.3748/wjg.v11.i9.1365 10.1055/s-0031-1291614 10.1136/gut.35.4.464 10.1378/chest.08-0670 10.2174/1568016052773315 10.1007/s11239-010-0536-7 10.1055/s-0037-1616087 10.1016/0002-9343(88)90105-2 10.1073/pnas.93.5.2149 |
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| References | Roche (R13-28-20210309) 1966; 15 Ledizet (R11-28-20210309) 2005; 3 Guerrouij (R3-28-20210309) 2011; 31 Taha (R7-28-20210309) 2006; 23 Lecleire (R14-28-20210309) 2012; 44 Johnsen (R1-28-20210309) 2001; 86 Wolf (R2-28-20210309) 2007; 102 Tabibian (R6-28-20210309) 1989; 84 Stassens (R12-28-20210309) 1996; 93 Rubin (R9-28-20210309) 2003; 58 Ansell (R4-28-20210309) 2008; 133 Thomopoulos (R8-28-20210309) 2005; 11 Gerson (R15-28-20210309) 2015; 110 Wilcox (R10-28-20210309) 1988; 84 Choudari (R5-28-20210309) 1994; 35 |
| References_xml | – volume: 84 start-page: 10 year: 1989 ident: R6-28-20210309 article-title: Acute gastrointestinal bleeding in anticoagulated patients: a prospective evaluation publication-title: Am J Gastroenterol – volume: 23 start-page: 489 year: 2006 ident: R7-28-20210309 article-title: Upper gastrointestinal mucosal abnormalities and blood loss complicating low-dose aspirin and antithrombotic therapy publication-title: Aliment Pharmacol Ther doi: 10.1111/j.1365-2036.2006.02784.x – volume: 102 start-page: 290 year: 2007 ident: R2-28-20210309 article-title: Impact of anticoagulation on rebleeding following endoscopic therapy for nonvariceal upper gastrointestinal hemorrhage publication-title: Am J Gastroenterol doi: 10.1111/j.1572-0241.2006.00969.x – volume: 58 start-page: 369 year: 2003 ident: R9-28-20210309 article-title: Acute GI bleeding in the setting of supratherapeutic international normalized ratio in patients taking warfarin: endoscopic diagnosis, clinical management, and outcomes publication-title: Gastrointest Endosc – volume: 15 start-page: 1029 year: 1966 ident: R13-28-20210309 article-title: The nature and causes of “ hookworm anemia” publication-title: Am J Trop Med Hyg doi: 10.4269/ajtmh.1966.15.1032 – volume: 110 start-page: 1265 year: 2015 ident: R15-28-20210309 article-title: ACG Clinical Guideline: diagnosis and management of small bowel bleeding publication-title: Am J Gastroenterol doi: 10.1038/ajg.2015.246 – volume: 11 start-page: 1365 year: 2005 ident: R8-28-20210309 article-title: Acute upper gastrointestinal bleeding in patients on long-term oral anticoagulation therapy: endoscopic findings, clinical management and outcome publication-title: World J Gastroenterol doi: 10.3748/wjg.v11.i9.1365 – volume: 44 start-page: 337 year: 2012 ident: R14-28-20210309 article-title: Yield and impact of emergency capsule enteroscopy in severe obscure-overt gastrointestinal bleeding publication-title: Endoscopy doi: 10.1055/s-0031-1291614 – volume: 35 start-page: 464 year: 1994 ident: R5-28-20210309 article-title: Acute gastrointestinal haemorrhage in anticoagulated patients: diagnoses and response to endoscopic treatment publication-title: Gut doi: 10.1136/gut.35.4.464 – volume: 133 start-page: 160s year: 2008 ident: R4-28-20210309 article-title: American College of Chest Physicians. Pharmacology and management of the vitamin K antagonists: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines (8th-edition) publication-title: Chest doi: 10.1378/chest.08-0670 – volume: 3 start-page: 1 year: 2005 ident: R11-28-20210309 article-title: Discovery and pre-clinical development of antithrombotics from hematophagous invertebrates publication-title: Curr Med Chem Cardiovasc Hematol Agents doi: 10.2174/1568016052773315 – volume: 31 start-page: 419 year: 2011 ident: R3-28-20210309 article-title: The clinical impact of bleeding during oral anticoagulant therapy: assessment of morbidity, mortality and post-bleed anticoagulant management publication-title: J Thromb Thrombolysis doi: 10.1007/s11239-010-0536-7 – volume: 86 start-page: 563 year: 2001 ident: R1-28-20210309 article-title: Hospitalisation for upper gastrointestinal bleeding associated with use of oral anticoagulants publication-title: Thromb Haemost doi: 10.1055/s-0037-1616087 – volume: 84 start-page: 683 year: 1988 ident: R10-28-20210309 article-title: Gastrointestinal bleeding in patients receiving long-term anticoagulant therapy publication-title: Am J Med doi: 10.1016/0002-9343(88)90105-2 – volume: 93 start-page: 2149 year: 1996 ident: R12-28-20210309 article-title: Anticoagulant repertoire of the hookworm Ancylostoma caninum publication-title: Proc Natl Acad Sci USA doi: 10.1073/pnas.93.5.2149 |
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| SubjectTerms | Albendazole - administration & dosage Anthelmintics - administration & dosage Anticoagulants - administration & dosage Anticoagulants - adverse effects Atrial Fibrillation - drug therapy Capsule Endoscopy - methods Clinical Case Report Diagnosis, Differential Diagnostic Errors - prevention & control Gastrointestinal Hemorrhage - diagnosis Gastrointestinal Hemorrhage - etiology Gastrointestinal Hemorrhage - therapy Hookworm Infections - complications Hookworm Infections - diagnosis Hookworm Infections - drug therapy Hookworm Infections - physiopathology Humans Jejunum - diagnostic imaging Jejunum - pathology Male Middle Aged Treatment Outcome Warfarin - administration & dosage Warfarin - adverse effects |
| Title | Acute major gastrointestinal bleeding caused by hookworm infection in a patient on warfarin therapy: A case report |
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