Medicine · 2026
Persimmon-induced excessive anticoagulation in a patient with mechanical heart valves receiving warfarin therapy: A case report.
СтатьяКлинический случайНазвание и аннотация: Перевод в очереди
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Kim JunSeok, Lee SongAm, Moon HyeongJu, Lee WooSurng
Аннотация
RATIONALE: Warfarin is a widely used vitamin K antagonist requiring strict international normalized ratio monitoring due to its narrow therapeutic window. While the interaction between warfarin and vitamin K-rich foods is well known, limited data exist regarding the anticoagulant effects of persimmons, a fruit rich in various bioactive compounds.
PATIENT CONCERNS: A 51-year-old woman with a history of double mechanical valve replacement presented for routine follow-up. She reported no symptoms or changes in medication but had consumed unripe persimmons ("Dangam") daily for 2 weeks prior to a sudden elevation in coagulation parameters.
DIAGNOSES: Routine laboratory testing revealed elevated prothrombin time and activated partial thromboplastin time without any signs of bleeding or other clinical abnormalities. The timing of the abnormal results suggested a possible food-drug interaction.
INTERVENTIONS: The patient was advised to discontinue persimmon intake immediately. Warfarin dosage was reduced from 4.25 to 3.5 mg without administering vitamin K supplementation. Coagulation parameters were monitored during this adjustment period.
OUTCOMES: Within 2 weeks, prothrombin time and activated partial thromboplastin time values returned to baseline. The patient remained stable on a slightly adjusted warfarin dose (3.25-3.9 mg), with no further abnormalities over the subsequent 3 years of follow-up. Over 9.5 years, she completed 63 visits with consistent international normalized ratio control.
LESSONS: This case highlights a potential food-drug interaction between persimmons and warfarin leading to excessive anticoagulation. The mechanism may involve more than vitamin K content alone, warranting further investigation. Physicians should consider dietary habits, including local or seasonal foods, in warfarin-treated patients presenting with unexpected coagulation changes.
PATIENT CONCERNS: A 51-year-old woman with a history of double mechanical valve replacement presented for routine follow-up. She reported no symptoms or changes in medication but had consumed unripe persimmons ("Dangam") daily for 2 weeks prior to a sudden elevation in coagulation parameters.
DIAGNOSES: Routine laboratory testing revealed elevated prothrombin time and activated partial thromboplastin time without any signs of bleeding or other clinical abnormalities. The timing of the abnormal results suggested a possible food-drug interaction.
INTERVENTIONS: The patient was advised to discontinue persimmon intake immediately. Warfarin dosage was reduced from 4.25 to 3.5 mg without administering vitamin K supplementation. Coagulation parameters were monitored during this adjustment period.
OUTCOMES: Within 2 weeks, prothrombin time and activated partial thromboplastin time values returned to baseline. The patient remained stable on a slightly adjusted warfarin dose (3.25-3.9 mg), with no further abnormalities over the subsequent 3 years of follow-up. Over 9.5 years, she completed 63 visits with consistent international normalized ratio control.
LESSONS: This case highlights a potential food-drug interaction between persimmons and warfarin leading to excessive anticoagulation. The mechanism may involve more than vitamin K content alone, warranting further investigation. Physicians should consider dietary habits, including local or seasonal foods, in warfarin-treated patients presenting with unexpected coagulation changes.