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However, she developed shock following brachial and retroperitoneal hemorrhage 4\u2009days after starting warfarin despite not being over-anticoagulated. She recovered after receiving blood transfusion and intravenous vitamin K2. Bleeding during warfarin administration occurs more frequently in older individuals with lower glomerular filtration rates, especially within the first 30\u2009days of warfarin treatment. Physicians should therefore check for unexpected bleeding after commencing warfarin and be prepared to reverse anticoagulation.<\/jats:p>","DOI":"10.1177\/2050313x18778380","type":"journal-article","created":{"date-parts":[[2018,5,22]],"date-time":"2018-05-22T00:43:56Z","timestamp":1526949836000},"update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":3,"title":["Multiple spontaneous hemorrhages after commencing warfarin therapy"],"prefix":"10.1177","volume":"6","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-1204-1294","authenticated-orcid":false,"given":"Nobuhiro","family":"Akuzawa","sequence":"first","affiliation":[{"name":"Department of General Medicine, National Hospital Organization Shibukawa Medical Center, Shibukawa, Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Masahiko","family":"Kurabayashi","sequence":"additional","affiliation":[{"name":"Department of Medicine and Biological Science, Graduate School of Medicine, Gunma University, Maebashi, Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"179","published-online":{"date-parts":[[2018,5,21]]},"reference":[{"key":"bibr1-2050313X18778380","first-page":"3","volume":"34","author":"Eikelboom J","year":"2016","journal-title":"Am J Med"},{"key":"bibr2-2050313X18778380","doi-asserted-by":"publisher","DOI":"10.5811\/westjem.2011.3.2051"},{"key":"bibr3-2050313X18778380","doi-asserted-by":"publisher","DOI":"10.1161\/JAHA.116.003725"},{"key":"bibr4-2050313X18778380","doi-asserted-by":"publisher","DOI":"10.1093\/ckj\/sfu080"},{"key":"bibr5-2050313X18778380","doi-asserted-by":"publisher","DOI":"10.1093\/eurheartj\/ehs253"},{"key":"bibr6-2050313X18778380","doi-asserted-by":"publisher","DOI":"10.1093\/eurheartj\/ehw210"},{"key":"bibr7-2050313X18778380","doi-asserted-by":"publisher","DOI":"10.1378\/chest.10-0134"},{"key":"bibr8-2050313X18778380","doi-asserted-by":"publisher","DOI":"10.1016\/j.jacc.2010.09.024"},{"key":"bibr9-2050313X18778380","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.h246"},{"key":"bibr10-2050313X18778380","doi-asserted-by":"publisher","DOI":"10.1093\/eurheartj\/eht499"},{"key":"bibr11-2050313X18778380","first-page":"CD011373","volume":"11","author":"Kimachi M","year":"2017","journal-title":"Cochrane Database Syst Rev"},{"key":"bibr12-2050313X18778380","doi-asserted-by":"publisher","DOI":"10.1016\/j.amjmed.2017.04.015"},{"key":"bibr13-2050313X18778380","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.k342"},{"key":"bibr14-2050313X18778380","doi-asserted-by":"publisher","DOI":"10.1160\/TH11-05-0364"},{"key":"bibr15-2050313X18778380","doi-asserted-by":"publisher","DOI":"10.1016\/j.thromres.2014.05.034"},{"key":"bibr16-2050313X18778380","doi-asserted-by":"publisher","DOI":"10.1007\/s00228-014-1739-1"},{"key":"bibr17-2050313X18778380","doi-asserted-by":"publisher","DOI":"10.1016\/j.jacc.2016.06.034"},{"key":"bibr18-2050313X18778380","doi-asserted-by":"publisher","DOI":"10.1007\/s11239-015-1248-9"},{"key":"bibr19-2050313X18778380","doi-asserted-by":"publisher","DOI":"10.1002\/phar.1401"},{"key":"bibr20-2050313X18778380","first-page":"951","volume":"10","author":"Chien KJ","year":"2013","journal-title":"Life Sci J"},{"key":"bibr21-2050313X18778380","doi-asserted-by":"publisher","DOI":"10.1016\/j.cjca.2015.05.012"}],"container-title":["SAGE Open Medical Case Reports"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/journals.sagepub.com\/doi\/pdf\/10.1177\/2050313X18778380","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/journals.sagepub.com\/doi\/full-xml\/10.1177\/2050313X18778380","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/journals.sagepub.com\/doi\/pdf\/10.1177\/2050313X18778380","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,5,1]],"date-time":"2026-05-01T00:35:30Z","timestamp":1777595730000},"score":1,"resource":{"primary":{"URL":"https:\/\/journals.sagepub.com\/doi\/10.1177\/2050313X18778380"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2018,1,1]]},"references-count":21,"alternative-id":["10.1177\/2050313X18778380"],"URL":"https:\/\/doi.org\/10.1177\/2050313x18778380","relation":{},"ISSN":["2050-313X","2050-313X"],"issn-type":[{"value":"2050-313X","type":"print"},{"value":"2050-313X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2018,1,1]]},"article-number":"2050313X18778380"}}