A Hemorrhagic Syndrome Due to Dicumarol Poisoning Masquerading as Propylthiouracil Sensitivity
Authors: R. T. BRECKENRIDGE
Journal: Annals of Internal Medicine (1964)

Brief Communication1 June 1964A Hemorrhagic Syndrome Due to Dicumarol Poisoning Masquerading as Propylthiouracil SensitivityR. T. BRECKENRIDGE, M.D., R. W. KELLERMEYER, M.D.R. T. BRECKENRIDGE, M.D.Search for more papers by this author, R. W. KELLERMEYER, M.D.Search for more papers by this authorAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/0003-4819-60-6-1066 SectionsAboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail ExcerptA few cases have been reported in which hemorrhagic syndromes associated with a lack of the vitamin K-dependent clotting factors were thought to have resulted from the ingestion of propylthiouracil (1-6). In the patient whose case is described here, hemorrhagic symptoms were attributed to the effects of propylthiouracil until a specific assay for bishydroxycoumarin was done on the patient's serum and medication. This case is reported to draw attention to the physical similarity between bishydroxycoumarin (Dicumarol®, Lustgarten) and propylthiouracil (Parke, Davis, and Co.) and to the possibility that one may be inadvertently confused with the other.METHODSBlood was collected...References1. CRADDOCKSHOTTONCROCKETTLEAVELL CGDCLBS: Severe hypoprothrombinemia following prophylthiouracil treatment of thyrotoxicosis. New Eng. J. Med. 244: 549, 1951. CrossrefMedlineGoogle Scholar2. MIERER GP: Hypoprothrombinemia following the use of prophylthiouracil: case report. Ann. Intern. Med. 43: 1124, 1955. LinkGoogle Scholar3. D'ANGELOGRESLEY GLP: Severe hypoprothrombinemia after prophylthiouracil therapy. Canad. Med. Ass. J. 81: 479, 1959. MedlineGoogle Scholar4. KOLARSGONYEA CPLM: Deficiency of prothrombin and proconvertin after therapy with prophylthiouracil. JAMA 171: 2315, 1959. CrossrefMedlineGoogle Scholar5. NAEYETERRIEU RLCM: Hemorrhagic state after therapy with prophylthiouracil. Amer. J. Clin. Path. 34: 254, 1960. CrossrefGoogle Scholar6. GREENSTEIN RH: Hypoprothrombinemia due to prophylthiouracil therapy. JAMA 173: 112, 1960. CrossrefGoogle Scholar7. BRECKENRIDGERATNOFF RTOD: Studies on the nature of the circulating anticoagulant directed against antihemophilic factor: with notes on an assay for antihemophilic factor. Blood 20: 137, 1962. CrossrefMedlineGoogle Scholar8. QUICK AJ: Clinical application of the hippuric acid and the prothrombin tests. Amer. J. Clin. Path. 10: 222, 1940. CrossrefGoogle Scholar9. ALEXANDER B: Estimation of plasma prothrombin by the one-stage method, in The Coagulation of Blood, Methods of Study, edited by TOCANTINS, L. M., Gune & Stratton, Inc., New York, 1955, p. 94. Google Scholar10. RATNOFFDAVIE ODEW: The activation of Christmas factor (Factor IX) by activated plasma thromboplastin antecedent (activated Factor IX). Biochemistry 1: 677, 1962. CrossrefGoogle Scholar11. AXELRODCOOPERBRODIE JJRBB: Estimation of dicumarol, 3, 3′-methylenebis (4-hydroxycoumarin) in biologic fluids. Proc. Soc. Exp. Biol. Med. 70: 693, 1949. CrossrefMedlineGoogle Scholar This content is PDF only. To continue reading please click on the PDF icon. Author, Article, and Disclosure InformationAffiliations: Cleveland, OhioFrom the Department of Medicine, Western Reserve University School of Medicine and University Hospitals of Cleveland, Cleveland, Ohio.This study was supported in part by research grants HE 01661 and AM-07841-01 from the National Institutes of Health, United States Public Health Service and in part by a grant from the Cleveland Area Heart Association.Dr. R. T. Breckenridge is the George and Anna Bishop Fellow in Medicine.Requests for reprints should be addressed to Robert T. Breckenridge, M.D., Department of Medicine, Lakeside Hospital, Cleveland 6, Ohio. PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetails Metrics Cited ByExtreme Warfarin Intoxication Secondary to Possible Covert Drug IngestionSurreptitious Ingestion of WarfarinHemorrhagic Diathesis Induced by Surreptitious Ingestion of Coumarin DrugsThe Anticoagulant Malingerer Psychiatric Studies of Three PatientsDAVID P. AGLE, M.D., OSCAR D. RATNOFF, M.D., F.A.C.P., GOTTFRIED K. SPRING, M.D.Surreptitious Ingestion of Coumarin Anticoagulant DrugsROBERT A. O'REILLY, M.D., F.A.C.P., PAUL M. AGGELER, M.D., F.A.C.P.Anticoagulant malingerers (the “dicumarol-eaters”) 1 June 1964Volume 60, Issue 6Page: 1066-1068KeywordsBloodHeartHospital medicineIngestionLongitudinal studiesMedical servicesPrevention, policy, and public healthResearch grants Issue Published: 1 June 1964 PDF DownloadLoading ...