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We present the case of a patient with advanced HCC whose prothrombin time \u2013 international normalized ratio (PT\u2010INR) was elevated after cotreatment with lenvatinib and warfarin potassium. The patient was a 26\u2010year\u2010old man with congenital abnormalities who had to take warfarin potassium because he had a mechanical heart valve. He was diagnosed with unresectable HCC at 24\u00a0years old and was treated by transcatheter arterial chemoembolization and transcatheter arterial infusion. After some interventional radiology treatments, lenvatinib was started. After 4\u00a0days of treatment with lenvatinib and warfarin potassium, his PT\u2010INR increased to 4.13, and the treatment had to be stopped. No changes were observed in other Child\u2013Pugh score factors. The elevation in the PT\u2010INR after cotreatment with lenvatinib and warfarin potassium was thought to be caused by pharmacological effects of concurrent use or pharmacological sensitivity to warfarin potassium in this patient with liver dysfunction. The PT\u2010INR must be monitored when lenvatinib is given to advanced HCC patients taking warfarin potassium.<\/jats:p>","DOI":"10.1111\/hepr.13379","type":"journal-article","created":{"date-parts":[[2019,5,23]],"date-time":"2019-05-23T14:29:25Z","timestamp":1558621765000},"page":"1357-1361","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":6,"title":["Cotreatment with lenvatinib and warfarin potassium caused prothrombin time prolongation"],"prefix":"10.1111","volume":"49","author":[{"given":"Yoichi","family":"Sasaki","sequence":"first","affiliation":[{"name":"Department of Gastroenterology and Hepatology Osaka University Graduate School of Medicine  Suita Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1580-607X","authenticated-orcid":false,"given":"Ryotaro","family":"Sakamori","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology and Hepatology Osaka University Graduate School of Medicine  Suita Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ryoko","family":"Yamada","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology and Hepatology Osaka University Graduate School of Medicine  Suita Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Minoru","family":"Shigekawa","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology and Hepatology Osaka University Graduate School of Medicine  Suita Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yuki","family":"Tahata","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology and Hepatology Osaka University Graduate School of Medicine  Suita Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yuki","family":"Makino","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology and Hepatology Osaka University Graduate School of Medicine  Suita Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tasuku","family":"Nakabori","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology and Hepatology Osaka University Graduate School of Medicine  Suita Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Takahiro","family":"Kodama","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology and Hepatology Osaka University Graduate School of Medicine  Suita Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2488-7315","authenticated-orcid":false,"given":"Hayato","family":"Hikita","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology and Hepatology Osaka University Graduate School of Medicine  Suita Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tomohide","family":"Tatsumi","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology and Hepatology Osaka University Graduate School of Medicine  Suita Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5036-3457","authenticated-orcid":false,"given":"Tetsuo","family":"Takehara","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology and Hepatology Osaka University Graduate School of Medicine  Suita Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2019,7,10]]},"reference":[{"key":"e_1_2_4_2_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(18)30207-1"},{"key":"e_1_2_4_3_1","doi-asserted-by":"publisher","DOI":"10.1111\/hepr.13181"},{"key":"e_1_2_4_4_1","doi-asserted-by":"publisher","DOI":"10.1111\/hepr.13294"},{"key":"e_1_2_4_5_1","doi-asserted-by":"crossref","first-page":"3930","DOI":"10.1016\/S0021-9258(18)92033-8","article-title":"Vitamin K and biosynthesis of protein and prothrombin","volume":"243","author":"Hill RB","year":"1968","journal-title":"J Biol Chem"},{"key":"e_1_2_4_6_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0083-6729(07)00007-6"},{"key":"e_1_2_4_7_1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJM198107303050502"},{"key":"e_1_2_4_8_1","doi-asserted-by":"publisher","DOI":"10.3748\/wjg.v9.i2.359"},{"key":"e_1_2_4_9_1","doi-asserted-by":"publisher","DOI":"10.3748\/wjg.v20.i26.8681"},{"key":"e_1_2_4_10_1","doi-asserted-by":"publisher","DOI":"10.1016\/0006-2952(66)90182-1"},{"key":"e_1_2_4_11_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0163-7258(96)00140-4"},{"key":"e_1_2_4_12_1","doi-asserted-by":"publisher","DOI":"10.1002\/jcph.813"},{"key":"e_1_2_4_13_1","doi-asserted-by":"publisher","DOI":"10.1002\/jcph.392"},{"key":"e_1_2_4_14_1","unstructured":"Food and Drug Administration (FDA) Prescribing information for lenvatinib. 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