An Unusual Consolidation: Lobar Pulmonary Hemorrhage Due to Antithrombotic Therapy

Abstract

Alveolar hemorrhage is a rare yet devastating clinical entity if not identified and treated aggressively. Exceedingly rare are the cases of anticoagulant-induced alveolar hemorrhage with very few cases described in the current literature. The nonspecific presentation of an alveolar hemorrhage makes its diagnosis and appropriate treatment difficult in the emergency department. We report a case of a patient on warfarin for atrial fibrillation who was initially misdiagnosed as having community-acquired pneumonia, but subsequently was identified to have a fatal alveolar hemorrhage.

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

“…[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 .…”

“…Following this, isolated reports have come up highlighting this rare clinical entity. [111213141516171819202122232425] A recent retrospective study from Japan[24] described the clinical features and outcome of DAH caused by antithrombotic therapy. In this study, 14/39 patients had DAH due to warfarin, with eight on monotherapy, whereas the remaining six were on other antithrombotic agents too.…”