Anticoagulants are indicated in all of the following conditions except: September 2005

Ans. C: Pericarditis The only common side effect of warfarin is hemorrhage. The risks of bleeding is increased when warfarin is combined with antiplatelet drugs such as clopidogrel, aspirin, or nonsteroidal anti-inflammatory drugs. The risk may also be increased in elderly patients and in patients on hemodialysis. A rare but serious complication resulting from treatment with warfarin is warfarin necrosis, which occurs more frequently in patients with a deficiency of protein C, leading to massive thrombosis with skin necrosis and gangrene of limbs. Its natural counterpa, purpura fulminans, occurs in children who are homozygous for protein C mutations. Warfarin could reduce bone mineral density and there is a direct link between warfarin use and osteoporosis-related fracture. Another rare complication that may occur early during warfarin treatment (usually within 3 to 8 weeks) is purple toe syndrome. It results from small deposits of cholesterol breaking loose and flowing into the blood vessels in the skin of the feet, which causes a blueish purple color and may be painful. It is typically affects the big toe. The effects of warfarin can be reversed with vitamin K, or, when rapid reversal is needed (such as in case of severe bleeding), with prothrombin complex concentrate--which contains only the factors inhibited by warfarin--or fresh frozen plasma in addition to intravenous vitamin K.