A life-threatening complication of warfarin therapy in ED: diffuse alveolar hemorrhage

Uysal, Ersin; Cevik, Erdem; Solak, Süleyman; Acar, Yahya Ayhan; Yalimol, Mustafa

doi:10.1016/j.ajem.2013.12.022

Cited by 13 publications

(8 citation statements)

References 8 publications

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“…[7] The risks of bleeding further increase because factors such as diet, concurrent medications, poor compliance, and alcohol consumption lead to fluctuating INR levels. [8] A search of the literature using PubMed, Cochrane, IndMed, Google, and other databases with the keywords “warfarin,” “acenocoumarol,” “Vitamin K antagonist,” and “diffuse alveolar haemorrhage” revealed 18 studies[4910111213141516171819202122232425] documenting 22 patients, which has been depicted in Table 1. Brown et al .…”

Section: Discussionmentioning

confidence: 99%

Warfarin-induced diffuse alveolar hemorrhage: Case report and a review of the literature

et al. 2019

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Diffuse alveolar hemorrhage (DAH) refers to the intra-alveolar accumulation of blood originating from the pulmonary microvasculature. This life-threatening condition is a medical emergency as patients often develop acute respiratory failure requiring invasive mechanical ventilation. This mandates for an early diagnosis with prompt and aggressive management strategies. A host of clinical disorders are known to cause DAH; however, warfarin-induced alveolar hemorrhage is a distinct clinical rarity. A search of the literature reveals few reports documenting this entity. A 27-year-old male presented with complaints of recent-onset hemoptysis and dyspnea. One month back, he was diagnosed with lower-limb deep-venous thrombosis and pulmonary embolism. He had been taking oral anticoagulants irregularly since then without monitoring of prothrombin time. Chest radiograph, done on presentation, revealed bilateral upper-lobe infiltrates, whereas computed tomography of the chest was suggestive of bilateral upper-lobe ground-glass opacities. Serial bronchoscopic alveolar lavage yielded samples which became progressively bloodier, whereas cytological evaluation of the sample revealed numerous alveolar macrophages with intracytoplasmic hemosiderin. A diagnosis of DAH due to warfarin was made, and the patient was administered Vitamin K followed by infusion of fresh frozen plasma. There was a marked clinical recovery, and the patient has been asymptomatic since then.

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Section: Discussionmentioning

confidence: 99%

Warfarin-induced diffuse alveolar hemorrhage: Case report and a review of the literature

et al. 2019

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“…However, the incidence of DAH in patients receiving anticoagulant therapy is low [5]. DAH secondary to warfarin therapy has been rarely reported [6, 7], but DAH is a serious adverse effect of dabigatran [8] and apixaban [9]. However, DAH associated with edoxaban has not been reported in the literature.…”

Section: Discussionmentioning

confidence: 99%

Diffuse Alveolar Hemorrhage Associated with Edoxaban Therapy

Nitta

Imamura

Yashio

et al. 2016

Case Reports in Critical Care

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Introduction. The main adverse effect of anticoagulant therapy is bleeding, and major bleeding, including intracranial, gastrointestinal, and retroperitoneal bleeding, has been reported as an adverse effect of edoxaban, a direct oral anticoagulant (DOAC). Bleeding during systemic anticoagulation with edoxaban presents a therapeutic conundrum, because there is currently no safe or efficacious reversal agent to stop major bleeding. Case Report. A 51-year-old woman had multiple traumatic injuries, including lower limb fractures. On day 8, she developed deep venous thrombosis, and edoxaban was administered orally. On day 38, she developed fungemia, which was treated with an antifungal drug. On day 43, she presented with dyspnea. Chest computed tomography scan showed bilateral diffuse ground-glass opacities in the whole lung fields. The results of the subsequent workup (i.e., serum levels of the antineutrophil cytoplasmic antibody, antinuclear antibody, and antiglomerular basement membrane antibody) and microbiological study were unremarkable. Based on these findings, her condition was diagnosed as diffuse alveolar hemorrhage (DAH) associated with edoxaban therapy. The lung opacities disappeared spontaneously after edoxaban therapy was discontinued. Conclusion. DAH is a dangerous complication associated with edoxaban therapy. DOACs, including edoxaban, should be prescribed with caution, especially for patients in a critical condition.

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“…), and idiopathic pulmonary haemosiderosis [ 1 ]. A few drugs, including the widely used anticoagulant warfarin, have been documented to cause this potentially lethal condition [ 2 , 3 ].…”

Section: Discussionmentioning

confidence: 99%