Key result
Warfarin-associated GI bleeding unmasks early colon cancer, indicating such bleeds may warrant full malignancy evaluation.
Case Report (n=1)
Minor gastrointestinal bleeding in patients on anticoagulants should be fully evaluated as it may unmask underlying malignancies.
May support malignancy evaluation after anticoagulant-related GI bleeding in select cases; leaves open whether systematic screening improves outcomes.
A 62-year-old Caucasian man with atrial fibrillation who was taking warfarin reported an episode of hematochezia; his international normalized ratio (INR) was 1.74. His weekly warfarin dose was increased by approximately 5%, and he was given three fecal occult blood cards. At follow-up 1 week later, the patient denied any episodes of hematochezia. His INR was 1.69 despite the increased warfarin dosage. One of the occult blood cards showed a positive result, and colonoscopy revealed a 5-cm lesion, identified as Dukes' A adenocarcinoma. Warfarin-associated bleeding generally is considered deleterious; however, in our patient it unmasked an early stage of colon cancer and thus may have saved the patient's life. Although minor gastrointestinal bleeding is common among patients taking anticoagulants, all patients should be fully evaluated because the source of hemorrhage may be malignant.
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McCall et al. (2002) conducted a case report in Atrial fibrillation (n=1). Warfarin was evaluated on Diagnosis of colon cancer. Warfarin-associated gastrointestinal bleeding unmasked an early stage of colon cancer in a 62-year-old man, demonstrating that such bleeding may warrant full evaluation for malignancy.
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