A Case Series on Bleeding Complications Secondary to Clopidogrel and Acenocoumarol: Clinical Patterns and Management Outcomes

Abstract

Drug-induced coagulopathy refers to life-threatening adverse effects associated with anticoagulant and antiplatelet drugs. This article describes a case series of clinical patterns and management outcomes of bleeding complications secondary to clopidogrel and acenocoumarol. In case of the first and second case reports, patients who were receiving aspirin and clopidogrel revealed spontaneous bleeding from the mucous membranes in the gastrointestinal tract. Their predisposition to hemorrhagic phenomena may be attributed to their advanced age, diabetes, ischemic heart disease and possible interactions between medications. Therefore, standard doses of clopidogrel and aspirin might induce hemorrhage in at-risk groups of patients. Supportive therapy was sufficient for stabilizing patients' conditions. The third, fourth and fifth case reports demonstrate the consequences of acenocoumarol overdose. Acenocoumarol is a vitamin K antagonist that interferes with the production of clotting factors II, VII, IX and X. As shown, there was a considerable increase in PT and INR (up to 8.6). The extent of bleeding symptoms, including hematemesis and melena with severe anemia, was directly proportional to the magnitude of INR. Treatment included the introduction of vitamin K and fresh frozen plasma, which contributed to normalizing blood coagulation. This review highlights that insufficient monitoring of INR is one of the key factors contributing to the development of drug-induced bleeding events. The current case reports reveal that older people, those with polypharmacy and patients with underlying cardiovascular pathologies are at increased risk of experiencing side effects related to anticoagulation therapy. As evidenced by the clinical cases, INR is reduced by vitamin K and FFP. Thus, this case series contributes to the discussion of the topic, adding specific data. In summary, this case series confirms the available information concerning the role of antiplatelet and anticoagulant drugs in drug-induced coagulopathy. The comparison with the results of a pharmacovigilance study strengthens the understanding that careful monitoring, individualized dose adjustment and proactive intervention are crucial for preventing this condition.