Diffuse alveolar hemorrhage in coumarin users: a fibrosing interstitial pneumonia trigger?

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Abstract

BACKGROUND: Fibrosing interstitial pneumonias (IPs) include idiopathic pulmonary fibrosis (IPF) and nonspecific interstitial pneumonia (NSIP). It has been suggested that oxidative damage plays a role in the pathophysiology of idiopathic interstitial pneumonias. Diffuse alveolar hemorrhage (DAH) can cause oxidative stress. Accordingly, we hypothesized that episodes of DAH might trigger fibrosing IP development. METHODS: Patients using coumarins with confirmed DAH were retrospectively gathered during a 9 year period and reviewed for the development of IPF or fibrosing NSIP. RESULTS: A total of 65 patients with DAH could finally be included, 31 (48 %) of whom subsequently developed a fibrosing IP. The majority of these 31 patients developed the fibrosing IP within 3 years after DAH confirmation. A total of 41 (63 %) patients died within 3.0 +/- 0.9 (range 1.3-4.7) years after the DAH diagnosis had been confirmed. Twenty-two of the deceased (54 %) had finally developed fibrosing IP. CONCLUSIONS: Almost half of the patients with established episodes of DAH developed fibrosing IP; therefore it seems that DAH might be a trigger for the development of fibrosing IP. This observation warrants prospective studies to further evaluate the clinical impact of these findings.
Original languageEnglish
Pages (from-to)53-59
Number of pages7
JournalLung
Volume191
Issue number1
DOIs
Publication statusPublished - Feb 2013

Keywords

  • Anticoagulants
  • Diffuse alveolar hemorrhage
  • Fibrosing interstitial pneumonia
  • Oxidative stress
  • IDIOPATHIC PULMONARY-FIBROSIS
  • VITAMIN-K DEFICIENCY
  • ACUTE LUNG INJURY
  • ACUTE MYOCARDIAL-INFARCTION
  • ACUTE EXACERBATION
  • OXIDATIVE STRESS
  • ANTICOAGULANT-THERAPY
  • DISEASE
  • ANTIOXIDANTS
  • WARFARIN

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