To the Editor: A 91-year-old woman was sent to the emergency department (ED) because of severe abdominal pain. She had a 10-year history of hypertension and atrial fibrillation under medical control. Warfarin 5 mg/d had been prescribed for atrial fibrillation, but she had increased the dosage to 5 mg twice a day for 3 days before ED admission without notifying her physician because she perceived that that would provide better symptom control. She denied any trauma history. Severe abdominal pain developed 6 hours after taking the second dose on the third day. Physical examination at the ED revealed diffuse abdominal tenderness with mild rebound pain. Vital signs were within the normal ranges. Coagulation tests revealed prolonged prothrombin time (PT; 27.7 seconds (normal range 8-12 seconds)) with an international normalized ratio of 2.86 and activated partial thromboplastin time (aPTT) of 56.6 seconds (normal range 23.3-39.3 seconds). Other blood tests were in the normal range. What is the final diagnosis?
展开▼
