Niacin induced coagulopathy as a manifestation of occult liver injury.

Niacin is an effective lipid-lowering agent which occasionally may cause hepatic failure. Liver enzymes are periodically tested during niacin therapy to assess for hepatic injury. We report a case of suppressed synthesis of hepatically derived coagulation factors and other liver proteins in a patient on niacin with no elevation of hepatic aminotransferases. The protein abnormalities reversed rapidly on discontinuation of niacin. It appears that niacin can cause occult liver injury without frank aminotransferase elevations, and may portend severe hepatotoxicity. Periodic assessment of prothrombin time should be considered in addition to aminotransferase levels to screen for liver injury. We believe this is the first reported case of occult hepatic injury due to extended release niacin, presenting as coagulopathy.