A case of severe embolic complications due to warfarin withdrawal

We report a case of three severe embolic complications due to warfarin withdrawal. An 83-year-old man with hypertension, angina pectoris and atrial fibrillation underwent bladder biopsy under spinal anesthesia after 13 days of warfarin withdrawal. On the second postoperative day, the patient complained of chest pain and was diagnosed as acute myocardial infarction. Embolus was successfully removed by suctioning. Warfarin and heparin therapy was started after that. On the 6th postoperative day, the patient complained of abdominal pain and was diagnosed as superior mesenteric artery embolism. After suctioning of the thrombus and monteplase injection, symptoms disappeared. On the 9th postoperative day, paralysis on the right side of his body and aphasia appeared. Stroke was suspected. Coma advanced day by day and he died due to brain herniation on the 16th postoperative day. In this patient we should have assessed the risk of the thromboembolic complication and planned the appropriate anticoagulation with closer cooperation with his attending physicians.