1. Volume 41, Issue 1, Pages 67-74 (July 2004)
Phenprocoumon-induced liver disease ranges from mild acute hepatitis to (sub-) acute liver failure 
Carl C. Schimanski, Jürgen Burg, Markus Möhler, Thomas Höhler, Stephan Kanzler, Gerd Otto, Peter R. Galle, Ansgar W. Lohse 
Journal of Hepatology 
Volume 41, Issue 1, Pages (July 2004)
DOI: /j.jhep

2. Fig. 1
(a)-(f): Histology of coumarin induced liver disease. (a) (Case 3) and (b) (Case 1): portal and lobular hepatitis with single cell (arrow) and massive bridging liver cell necrosis of at least 60% of the liver parenchyma. The vital hepatocytes exhibited degenerative changes with ballooning. (c) (Case 5) bile duct alterations with an increase in plasma cells and eosinophils. (d) (Case 1) alteration of the small bile ducts with degenerative changes (arrow). (e) (Case 6) hepatitic changes with marked activity and confluent liver cell necrosis (zone III) accompanied by some ceroid-laden macrophages (arrow). (f) (Case 4) inactive portal hepatits and a granulomatous intraparenchymal aggregate (inlet picture) of epitheloid histiocytes.
Journal of Hepatology  , 67-74DOI: ( /j.jhep )

3. Fig. 2
Displays a provocation test in patient 4. After cession of phenprocoumon therapy and anticoagulation with LMWH , liver enzymes began to decrease immediately. Three weeks later, liver enzymes had dropped by half and a therapy with Warfarin was initiated. Warfarin had been given for 3 days, when liver enzymes rapidly augmented again. Warfarin was thus replaced by LWMH few days later and liver enzymes immediatelly decreased. Thus, this patient displays the picture of a drug provocation by a cross reacting coumarin.
Journal of Hepatology  , 67-74DOI: ( /j.jhep )

4. Fig. 2
Displays a provocation test in patient 4. After cession of phenprocoumon therapy and anticoagulation with LMWH , liver enzymes began to decrease immediately. Three weeks later, liver enzymes had dropped by half and a therapy with Warfarin was initiated. Warfarin had been given for 3 days, when liver enzymes rapidly augmented again. Warfarin was thus replaced by LWMH few days later and liver enzymes immediatelly decreased. Thus, this patient displays the picture of a drug provocation by a cross reacting coumarin.
Journal of Hepatology  , 67-74DOI: ( /j.jhep )

5. Fig. 2
Displays a provocation test in patient 4. After cession of phenprocoumon therapy and anticoagulation with LMWH , liver enzymes began to decrease immediately. Three weeks later, liver enzymes had dropped by half and a therapy with Warfarin was initiated. Warfarin had been given for 3 days, when liver enzymes rapidly augmented again. Warfarin was thus replaced by LWMH few days later and liver enzymes immediatelly decreased. Thus, this patient displays the picture of a drug provocation by a cross reacting coumarin.
Journal of Hepatology  , 67-74DOI: ( /j.jhep )

6. Fig. 2
Displays a provocation test in patient 4. After cession of phenprocoumon therapy and anticoagulation with LMWH , liver enzymes began to decrease immediately. Three weeks later, liver enzymes had dropped by half and a therapy with Warfarin was initiated. Warfarin had been given for 3 days, when liver enzymes rapidly augmented again. Warfarin was thus replaced by LWMH few days later and liver enzymes immediatelly decreased. Thus, this patient displays the picture of a drug provocation by a cross reacting coumarin.
Journal of Hepatology  , 67-74DOI: ( /j.jhep )

7. Journal of Hepatology 2004 41, 67-74DOI: (10.1016/j.jhep.2004.03.010)

8. Journal of Hepatology 2004 41, 67-74DOI: (10.1016/j.jhep.2004.03.010)

9. Journal of Hepatology 2004 41, 67-74DOI: (10.1016/j.jhep.2004.03.010)