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Transient increase in international normalized ratio (INR) and bleeding risk following Alendronate sodium in elderly patients on warfarin: Two case reports

INTRODUCTION: Alendronate sodium is used to reduce the risk of bone fracture in aged osteoporosis patients. However, its side effects should be recognized, especially for those aged patients with one or more basic cardiovascular diseases. PATIENT CONCERNS: A 90-year-old and a 75-year-old male patien...

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Autores principales: Qian, Sufeng, Zhou, Jia, Bian, Pingda, Shi, Lingfei
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Wolters Kluwer Health 2020
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6959961/
https://www.ncbi.nlm.nih.gov/pubmed/31914073
http://dx.doi.org/10.1097/MD.0000000000018698
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author Qian, Sufeng
Zhou, Jia
Bian, Pingda
Shi, Lingfei
author_facet Qian, Sufeng
Zhou, Jia
Bian, Pingda
Shi, Lingfei
author_sort Qian, Sufeng
collection PubMed
description INTRODUCTION: Alendronate sodium is used to reduce the risk of bone fracture in aged osteoporosis patients. However, its side effects should be recognized, especially for those aged patients with one or more basic cardiovascular diseases. PATIENT CONCERNS: A 90-year-old and a 75-year-old male patient were admitted to our department. These 2 patients were examined by dual energy X-ray absorptiometry (DXA). DIAGNOSIS: Both patients were diagnosed with osteoporosis, they also had history of atrial fibrillation (AF) and had long term use of warfarin. INTERVENTIONS: Alendronate sodium was prescribed to the two patients at 70 mg once a week. OUTCOMES: The 2 patients had experienced dramatic increase of international normalized ratio (INR) to 4.69∼4.86 within 24 hours and gradual decrease in the next 5 days. Both patients experienced spontaneous ecchymoses and petechiae in the skin at the first 72 hours. CONCLUSION: Alendronate sodium can transiently increase the INR over 50%, induce spontaneous ecchymoses and petechiae in the skin of aged male osteoporosis patients with AF who took warfarin. Clinicians should pay enough attention when using alendronate sodium on these kinds of patients and be aware of the consequent potential bleeding risk.
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spelling pubmed-69599612020-01-31 Transient increase in international normalized ratio (INR) and bleeding risk following Alendronate sodium in elderly patients on warfarin: Two case reports Qian, Sufeng Zhou, Jia Bian, Pingda Shi, Lingfei Medicine (Baltimore) 4600 INTRODUCTION: Alendronate sodium is used to reduce the risk of bone fracture in aged osteoporosis patients. However, its side effects should be recognized, especially for those aged patients with one or more basic cardiovascular diseases. PATIENT CONCERNS: A 90-year-old and a 75-year-old male patient were admitted to our department. These 2 patients were examined by dual energy X-ray absorptiometry (DXA). DIAGNOSIS: Both patients were diagnosed with osteoporosis, they also had history of atrial fibrillation (AF) and had long term use of warfarin. INTERVENTIONS: Alendronate sodium was prescribed to the two patients at 70 mg once a week. OUTCOMES: The 2 patients had experienced dramatic increase of international normalized ratio (INR) to 4.69∼4.86 within 24 hours and gradual decrease in the next 5 days. Both patients experienced spontaneous ecchymoses and petechiae in the skin at the first 72 hours. CONCLUSION: Alendronate sodium can transiently increase the INR over 50%, induce spontaneous ecchymoses and petechiae in the skin of aged male osteoporosis patients with AF who took warfarin. Clinicians should pay enough attention when using alendronate sodium on these kinds of patients and be aware of the consequent potential bleeding risk. Wolters Kluwer Health 2020-01-10 /pmc/articles/PMC6959961/ /pubmed/31914073 http://dx.doi.org/10.1097/MD.0000000000018698 Text en Copyright © 2020 the Author(s). Published by Wolters Kluwer Health, Inc. http://creativecommons.org/licenses/by/4.0 This is an open access article distributed under the Creative Commons Attribution License 4.0 (CCBY), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. http://creativecommons.org/licenses/by/4.0
spellingShingle 4600
Qian, Sufeng
Zhou, Jia
Bian, Pingda
Shi, Lingfei
Transient increase in international normalized ratio (INR) and bleeding risk following Alendronate sodium in elderly patients on warfarin: Two case reports
title Transient increase in international normalized ratio (INR) and bleeding risk following Alendronate sodium in elderly patients on warfarin: Two case reports
title_full Transient increase in international normalized ratio (INR) and bleeding risk following Alendronate sodium in elderly patients on warfarin: Two case reports
title_fullStr Transient increase in international normalized ratio (INR) and bleeding risk following Alendronate sodium in elderly patients on warfarin: Two case reports
title_full_unstemmed Transient increase in international normalized ratio (INR) and bleeding risk following Alendronate sodium in elderly patients on warfarin: Two case reports
title_short Transient increase in international normalized ratio (INR) and bleeding risk following Alendronate sodium in elderly patients on warfarin: Two case reports
title_sort transient increase in international normalized ratio (inr) and bleeding risk following alendronate sodium in elderly patients on warfarin: two case reports
topic 4600
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6959961/
https://www.ncbi.nlm.nih.gov/pubmed/31914073
http://dx.doi.org/10.1097/MD.0000000000018698
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