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Black licorice ingestion: Yet another confounding agent in patients with melena.
MedLine Citation:
PMID:  21160832     Owner:  NLM     Status:  PubMed-not-MEDLINE    
Abstract/OtherAbstract:
We describe an 80-year-old woman with atrial fibrillation, anti-coagulated with warfarin, who on two separate occasions developed black tarry stools and an elevated international normalized ratio (INR) after eating a pound of Black Licorice. During her most recent episode, her hematocrit was 14 (baseline 34) and her INR was 5.5 (baseline 2.1). She was advised to restrict licorice consumption, and a follow-up INR two weeks later was 1.2. Black Licorice is derived from the root of the plant, Glycyrrhiza glabra. The components of its extract inhibit the P450 system enzymes that metabolize Warfarin, inhibit thrombin, and prolong fibrinogen clotting times. Hence, the anti-thrombotic activity and inhibition of warfarin metabolism might synergistically amplify anti-coagulation. The presence of Black Licorice in the stool can also mimic melena and confound its clinical presentation. Health care providers should caution patients who are at risk for bleeding or on warfarin to avoid black licorice due to an elevated risk of gastrointestinal bleeding.
Authors:
Judy Fong Liu; Arun Srivatsa; Vivek Kaul
Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  World journal of gastrointestinal surgery     Volume:  2     ISSN:  1948-9366     ISO Abbreviation:  World J Gastrointest Surg     Publication Date:  2010 Jan 
Date Detail:
Created Date:  2010-12-16     Completed Date:  2011-07-14     Revised Date:  2013-05-29    
Medline Journal Info:
Nlm Unique ID:  101532473     Medline TA:  World J Gastrointest Surg     Country:  China    
Other Details:
Languages:  eng     Pagination:  30-1     Citation Subset:  -    
Affiliation:
Judy Fong Liu, Arun Srivatsa, Vivek Kaul, University of Rochester, School of Medicine and Dentistry, Rochester, NY 14642, United States; Strong Memorial Hospital/University of Rochester, Medical Center, Division of Gastroenterology & Hepatology, Department of Internal Medicine, Rochester, NY 14642, United States.
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