Acenocoumarol as an alternative anticoagulant in a patient with warfarin-related nephropathy.

ADVERSE EVENT: Warfarin-related nephropathy. DRUG IMPLICATED: Warfarin. THE PATIENT: A 31-year-old female, managed with warfarin for rheumatic heart disease with atrial fibrillation. EVIDENCE THAT LINKS THE DRUG TO THE EVENT: There were no alternative causes of nephropathy that could have caused the adverse event in this patient. MANAGEMENT: Shifting the drug from warfarin to acenocoumarol. MECHANISM: Difference in renal elimination between warfarin and acenocoumarol. IMPLICATION FOR THERAPY: Clinicians should be aware of this rare adverse effect of warfarin, and acenocoumarol can be considered as an alternative therapy for this condition. HYPOTHESES TO BE TESTED: Further prospectively designed studies are needed to consider acenocoumarol as an alternative therapy in warfarin-related nephropathy.