Subacute liver failure induced by phenprocoumon treatment

We report on a 39-year-old woman suffering from deep venous thrombosis due to a heterozygous factor-V-leiden mutation with resistance to activated pro tein C. Four months after beginning oral anticoagulation, generalized jaund ice appeared. Subsequently, subacute liver failure developed necessitating an orthotopic liver transplantation. Histopathology showed features of exte nsive liver cell necrosis without evidence of a substantial inflammatory in filtrate. Based on histopathology and exclusion of other liver diseases, ph enprocoumon-induced liver failure was diagnosed. Five months after transpla ntation the patient is well with normal liver function tests. Because of th e widespread use of oral anticoagulants, not only bleeding complications bu t also hepatotoxicity should be considered in therapy supervision.