Self-assessment questions Unusual findings in a patient taking warfarin

A 60-year-old man was admitted with a 48-hour history of left-sided abdominal pain. He was receiving anticoagulation therapy with warfarin for a prosthetic aortic valve. His INR on admission was 4.1. Initial full blood count, urine microscopy and plain abdominal radiographs were normal. He underwent an abdominal computed tomography (CT) scan (figure 1). Within 24 hours the patient developed ecchymoses in the peri-umbilical region, both flanks, and down the left lower limb from the thigh to the lateral aspect of the foot (figure 2).