Introduction: The use of anticoagulant medication is more frequent in the treatment and prophylaxis of arterio-venous thrombotic events. Oral anticoagulants, as acenocoumarol, are characterized by an inter-individual variability concerning the treatment response. Knowing the pharmacokinetics, dosage and the management of coumarin anticoagulants is particularly important in daily practice.
Case presentation: We present the clinical case of a 64-year old hypertensive, diabetic patient, known to have liver cirrhosis, a history of pulmonary thromboembo-lism, and permanent electrical cardiac stimulation type VVI (for total atrioventricular block with syncope), ad-mitted in emergency for a giant hematoma in the right popliteal region, the patient being ambulatory under treatment with oral anticoagulant.The investigations carried out, objectified the ischemic and hypertensive cardiac pathology, the presence of cardiomegaly and the modification of segmentary parietal kinetics, with the detection of valvular atherosclerotic injuries involved in the mixed etiology of valvular regurgitation, as well as the severe evolution of chronic liver disease (the patient being within the Child–Pugh class B with a MELD score=19 and in stage III according to the BA-VENO IV consensus), with changes in echo structu-re and with hypersplenism expressed by bicitopenia, and hypocoagulability (INR=6,5). Under the complex treatment, was obtained the resorption of the right po-pliteal hematoma and resuming of walking autonomy. The presence of hemorrhagiparous syndrome, required the reevaluation of the basic treatment and the benefit/ risk balance, being recommended an antiplatelet mo-notherapy at home.
Conclusions: Anticoagulant therapy is a constantly evolving medical field. The hemorrhagic risk is directly proportional to the intensity of anticoagulation. The liver’s role in the hemostasis process is incontestable, the hepatocyte being the site of synthesis for most of the coagulation factors. Antithrombotic therapy must be performed according to the current guidelines, and the benefit/risk balance evaluated for each distinct pa-tient.