Which of the following lists signs of bleeding that can occur with warfarin therapy?

• A. Ringing in ears; Hair loss; Nausea; Dizziness
• B. Bleeding gums; Bruising; Hematuria; Black stool
• C. Cough; Shortness of breath; Fever
• D. Confusion; Seizures; Tremors

Answer: (B)

Warfarin raises the risk of bleeding because it lowers the production of vitamin K–dependent clotting factors, so look for signs that bleeding is occurring. The combination of bleeding gums, easy bruising, blood in the urine (hematuria), and black, tarry stools is classic for anticoagulation-related bleeding. Gum bleeding and bruising reflect mucosal and soft-tissue bleeding, while hematuria and dark stools point to internal bleeding in the urinary tract and GI tract, respectively. The other choices describe symptoms more typical of infection, respiratory or neurologic issues, or non-bleeding problems, not the bleeding manifestations expected with warfarin therapy.

If these signs appear, it’s important to seek medical evaluation promptly to assess bleeding risk and adjust treatment.