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Indanedione anticoagulants
General information
Indanediones have the same mechanism of action as the coumarins. However, they are generally more toxic than the coumarins, and can cause allergic reactions capable of involving many organs and sometimes resulting in death [ ]. These reactions are mainly observed with phenindione and are very rare with other indanediones, such as fluindione.
In an MRC trial, there was a 2.25% incidence of reactions, which necessitated withdrawal of phenindione [ ].
Organs and systems
Cardiovascular
As with the coumarins, the main complication of the indanediones is bleeding. The incidence of hemorrhage varies, depending on age, the intensity of treatment, and the indication. Hematuria, bruising, and gastrointestinal bleeding are the commonest signs. The most common site of fatal hemorrhage is intracranial [ ].
Hematologic
Agranulocytosis can occur during the first month of treatment with phenindione [ ]. Anemia, thrombocytopenia [ ], and leukemoid reactions [ ] have also been described.
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