Management of upper airway obstruction secondary to warfarin therapy: the conservative approach

Lim, Ming Yann; Chaudhari, Meena; Devesa, Pablo; Waddell, A. W.; Gupta, Deepak

doi:10.1017/s0022215105001982

Cited by 25 publications

(26 citation statements)

References 7 publications

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“…There have been several reported cases of such haematomas in different locations in the upper airway in anticoagulated patients 1–5. To our knowledge, this is the first reported case of spontaneous synchronous sublingual and supraglottic haematomas.…”

Section: Introductionmentioning

confidence: 61%

A rare cause of upper airway obstruction: spontaneous synchronous sublingual and laryngeal haematomas

Parvizi

MacKeith²,

Draper³

2011

Case Reports

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Section: Introductionmentioning

confidence: 61%

A rare cause of upper airway obstruction: spontaneous synchronous sublingual and laryngeal haematomas

Parvizi

MacKeith²,

Draper³

2011

Case Reports

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“…It also needs to be group specific. FFP is however, less expensive than prothrombin complex concentrate and is argued to have a lower risk of thromboembolism [6,7]. Intravenous vitamin K and fresh frozen plasma are therefore generally used for less severe bleeding, and provide a more gradual reversal.…”

Section: Discussionmentioning

confidence: 99%

Massive sublingual hematoma secondary to anticoagulant therapy complicated by a traumatic denture: a case report

et al. 2012

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IntroductionSublingual hematoma secondary to excessive anticoagulation is a rare but potentially fatal condition, and few cases have been documented in the literature.Case presentationWe report the case of a 73-year-old Caucasian woman who attended our Accident and Emergency department with massive sublingual hematoma causing superior displacement of the tongue. The condition was found to be the result of an elevated international normalized ratio, further complicated by a traumatic mandibular denture.ConclusionsIn summary, we recommend the immediate reversal of anticoagulation therapy on admission of patients with severe sublingual hematoma. We further advise surgical decompression/drainage if required and to continue meticulous monitoring. In all cases of early recognition of sublingual hematoma, prompt medical treatment and continuous clinical monitoring is essential, and may prevent the need for a surgical airway procedure.

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“…Bu nedenle bu bölgede yer kaplayan lezyonlar, hızlı bir şekilde hava yolu bütünlüğünü tehlikeye sokabilir ve acil müdahale gerekebilir. Hafif ve orta derecede obstrüksiyon bulguları olan hastalarda genel yaklaşım, fleksibl laringoskopi ile hava yolunun değerlendirilmesi, hava yolunun yakından izlenmesi, oksijen tedavisi ve pıhtılaşma bozukluğunun vitamin K ve taze donmuş plazma ile tedavisidir (12). Bununla birlikte, hastalara rutin entübasyon veya trakeotomi/krikotirotomi yapılması gerektiğini belirten görüşler de vardır (2,4,13,14).…”

Section: Discussionunclassified

Pharyngeal Hematoma Secondary to Anticoagulant Therapy: Case Report

Kaya¹,

Ceylan²,

Kocak³

et al. 2012

Turk J Anesth Reanim

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Hematomas secondary to anticoagulant therapy, inducing upper airway obstruction, are mostly located in the retropharyngeal, sublingual, submandibular and, rarely, laryngeal space. Most are managed conservatively but sometimes endotracheal intubation and emergency tracheotomy are necessary. We report a case of asphyxia due to a pharyngeal hematoma secondary to warfarin use, admitted to the emergency service with cardiopulmonary arrest.A 48 year-old woman presented at the emergency service with sore throat and difficulty in swallowing in the morning. After evaluation of the oropharynx, she was referred to the ear-nose throat clinic. However, on the same day, she presented at the emergency service with cardiopulmonary arrest. Direct laryngoscopy revealed a posterior pharyngeal mass or hematoma. Repeated intubation attempts failed. Despite the application of a laryngeal mask, she could not be ventilated and an emergency tracheostomy was performed. In her medical history, it was learned that she was taking warfarin for mitral stenosis. INR values were unmeasurably high. Fresh frozen plasma and vitamin K treatment were started. A computed tomography scan of the neck and cranium revealed extensive cerebral edema and a lesion in the pharynx, not distinguishable between bleeding and tumor and almost completely obstructing the airway. On the second day, her renal function deteriorated and she developed hypernatremia. The patient died due to multiorgan failure on the 5 th day.In patients using anticoagulants and presenting with symptoms like sore throat, odynophagia, dysphagia and hoarseness, pharyngeal hematoma should be excluded. Early diagnosis increases the success of conservative treatment and can be life-saving by preventing prolonged airway attempts.

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Management of upper airway obstruction secondary to warfarin therapy: the conservative approach

Cited by 25 publications

References 7 publications

A rare cause of upper airway obstruction: spontaneous synchronous sublingual and laryngeal haematomas

A rare cause of upper airway obstruction: spontaneous synchronous sublingual and laryngeal haematomas

Massive sublingual hematoma secondary to anticoagulant therapy complicated by a traumatic denture: a case report

Pharyngeal Hematoma Secondary to Anticoagulant Therapy: Case Report

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