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	Since this article does not have an abstract, we have provided the first 150 words of the full text and any section headings.

Anabolic, androgenic steroids have been linked with thrombotic events. Conversely, decreased coagulation has been anecdotally associated with androgens when given with warfarin. Oxandrolone is a 17-alkylated testosterone derivative, modified to permit absorption through the gastrointestinal tract. It was approved in 1964 for osteoporotic bone pain and to facilitate weight gain after chronic infection, corticosteroid use, surgery, or trauma. It has been used off-label for AIDS-related cachexia and for the short stature of constitutional delay and Turner syndrome.

Warfarin, an anticoagulant with a narrow therapeutic window, is a racemic mixture with the more potent S-enantiomer metabolized primarily through cytochrome P450 2C9 pathway and the R-enantiomer by cytochrome P450 1A2 and 3A4. Inhibition of its metabolism, especially via the 2C9 pathway, is associated with bleeding, although most drug interactions with warfarin are minor.

We have identified a case of frank bleeding in a 93-year-old woman after the addition of oxandrolone (2.5 . . . [Full Text of this Article]

AUTHOR INFORMATION
Elizabeth A. Koller, MD; Xiaoxiong Wei, MD, PhD; Timothy E. Johnson, PA

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