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Frederick Littleton, Jr, MD
Kilmarnock, Va

JAMA. 1990;263(21):2888.

	Since this article does not have an abstract, we have provided the first 150 words of the full text PDF and any section headings.

To the Editor.—

Two patients who were receiving maintenance warfarin therapy and who experienced marked prolongation of the prothrombin time by topical nonprescription medications are described.

Report of Cases. —

CASE 1.—An 85-year-old woman was admitted to the hospital with an acute pulmonary embolism. She had congestive heart failure and atrial fibrillation and received anticoagulation therapy with heparin followed by warfarin. After a 12-day hospitalization, she was discharged with a prothrombin time of 1.5 times the control value.

She presented subsequently with vaginal bleeding, irregular tachycardia, and orthostatic hypotension. Ecchymoses were seen on the left cheek, the right flank, and the perineum and gross bleeding from the vagina was evident. The hemoglobin was 80 g/L; it had been 117 g/L 2 months previously. The prothrombin time was 55.0 seconds, with a control value of 12.4 seconds; it had been 18.5 seconds with a similar control value 1 week previously. . . . [Full Text PDF of this Article]

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