Warfarin-associated thoracic aortic dissection in an elderly woman

Background: the risk/benefit ratio of warfarin therapy changes in the over 75s, when haemorrhagic side-effects become more common. These may not always be reported in the literature. Case report: a woman of 80 years, on long-term warfarin therapy presented with an acute dissecting thoracic aortic aneurysm;; on investigation the only precipitating factor found was an international normalised ratio of 4.8. This patient, who also had an abdominal aortic aneurysm, survived, on discontinuation of her anticoagulant therapy. Conclusions: we describe a previously unreported complication of warfarin therapy in a patient over 75 years of age, to add to the cautions in prescribing this drug in patients of this age group.