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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.

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Authors and Affiliations

  1. Department of Clinical Chemistry, Maastricht University Medical Centre+ (MUMC+), Maastricht, The Netherlands

    Petal A. Wijnen & Otto Bekers

  2. Department of Radiology, University Hospital Gasthuisberg, Leuven, Belgium

    Johny A. Verschakelen

  3. Department of Toxicology, University Maastricht, Maastricht, The Netherlands

    Aalt Bast

  4. Faculty of Health, Medicine and Life Sciences, University Maastricht, P.O. Box 3100, 6202 NC, Maastricht, The Netherlands

    Marjolein Drent

  5. Department of Interstitial Lung Diseases, Hospital Gelderse Vallei, Ede, The Netherlands

    Marjolein Drent

Authors
  1. Petal A. Wijnen
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  2. Johny A. Verschakelen
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  3. Aalt Bast
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  4. Otto Bekers
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  5. Marjolein Drent
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Correspondence to Marjolein Drent.

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Wijnen, P.A., Verschakelen, J.A., Bast, A. et al. Diffuse Alveolar Hemorrhage in Coumarin Users: A Fibrosing Interstitial Pneumonia Trigger?. Lung 191, 53–59 (2013). https://doi.org/10.1007/s00408-012-9436-2

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  • DOI: https://doi.org/10.1007/s00408-012-9436-2

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