Pulmonary Edema Secondary to Warfarin-Induced Sublingual and Laryngeal Hematoma

Bachmann, Patrick; Gaussorgues, P.; Pignat, J.-C.; Gueugniaud, Pierre‐Yves; Piperno, D.; Jaboulay, J.M.; Robert, Dominique

doi:10.1097/00003246-198711000-00021

Cited by 14 publications

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“…The mean dose of warfarin taken by the patients was 5.34 ± 2.58 mg. The indications for warfarin were as follows: Mechanical valves (MVs) ( n = 11, 29.73%),[ 2 4 5 6 7 8 9 10 11 ] atrial fibrillation (AF) ( n = 10, 27.03%),[ 3 12 13 14 15 16 17 18 19 20 ] venous thromboembolism (VTE) ( n = 9, 24.32%),[ 1 21 22 23 24 25 26 27 28 ] chronic thrombophlebitis ( n = 2, 5.41%),[ 29 30 ] and polycythemia vera ( n = 1, 2.70%). [ 31 ] The indication of anticoagulation was unclear in four cases.…”

Section: Resultsmentioning

confidence: 99%

“…Conservative management with vitamin K, fresh frozen plasma (FFP), or prothrombin complex concentrate (PCC) was instituted in 18 (48.65%)[ 2 3 6 8 9 11 12 13 14 15 17 18 19 20 27 32 ] cases Table 2 . Cricothryrotomy was performed in two (5.41%) cases,[ 21 23 ] tracheotomy in 12 (32.43%) cases,[ 1 4 5 11 21 22 23 24 25 26 31 33 ] endotracheal intubation in five (13.51%) cases,[ 1 4 10 22 28 ] nasotracheal intubation in four (10.81%) cases,[ 5 7 16 29 ] and surgical evacuation of hematoma in two (5.41%) cases. [ 4 7 ]…”

Section: Resultsmentioning

confidence: 99%

“…Most of the cases had a good outcome with the mean duration to resolution being 7.69 ± 5.44 days. The complications included respiratory compromise in 18 cases (48.65%), pulmonary edema,[ 21 ] aspiration pneumonia,[ 22 ] and mild pneumonitis[ 23 ] in one case each. One patient died due to anoxic brain injury.…”

Section: Resultsmentioning

confidence: 99%

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Upper airway hematoma secondary to warfarin therapy: A systematic review of reported cases

et al. 2015

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Upper airway hematoma (UAH) is a rare but life-threatening complication of oral anticoagulants requiring early recognition. However, no consensus exists regarding the best approach to treatment. We therefore, sought to systematically review the published literature on UAH to elaborate its demographic and clinical characteristics, treatment, complications, and outcomes. A systematic electronic search of PubMed and EMBASE for case reports, case series, and related articles of UAH related to warfarin published from inception (November 1950) to March 2015 was carried out. Categorical variables were expressed as percentage and continuous variables as mean ± standard deviation (SD). Statistical analysis was done using Statistical Package for the Social Sciences (SPSS) version 20.0. All cases were reported to have UAH as a complication of anticoagulation therapy with warfarin. Demographic and clinical characteristics, treatment, complications and outcomes of UAH were studied. Thirty-eight cases of UAH were identified from 34 reports in the literature. No gender preponderance (male = 52.78%) was seen and the average age of presentation was 60.11 ± 12.50 years. Dysphagia, sore throat, and neck swelling were the most common symptoms and the mean international normalized ratio (INR)at presentation was 8.07 ± 4.04. Most cases had sublingual hematoma (66.57%) followed by retropharyngeal hematoma (27.03%). Of the cases, 48.65% were managed conservatively while the rest underwent either cricothyrotomy or intubation with the time to resolution being 7.69 ± 5.44 days. UAH is a rare butpotentially serious complication of warfarin therapy. It is more common in the elderly population with supratherapeutic INR; inciting events were present in many cases. Overall, it has a good prognosis with significant morbidity present only if concomitant respiratory compromise is present. Reversal of anticoagulation with low threshold for artificial airway placement in the event of airway compromise leads to a favorable outcome in most cases.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

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Upper airway hematoma secondary to warfarin therapy: A systematic review of reported cases

et al. 2015

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“…During the use of warfarin, a significant life-threatening complication is haemorrhage. Although rare, spontaneous upper airway hematoma haemorrhage in patients on anticoagulant therapy of varying severity has been reported [3–9]. Most upper airway hematomas were sublingual hematomas (66.57%) followed by retropharyngeal hematomas (27.03%).…”

Section: Discussionmentioning

confidence: 99%

Denture Induced Submandibular Hematoma in a Patient on Warfarin

Yeap

Muniandy

Hang

2018

Case Reports in Anesthesiology

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A 79-year-old lady, who was taking warfarin, presented to the Emergency Department with a painless anterior neck swelling, which was associated with hoarseness of voice, odynophagia, and shortness of breath. She first noticed the swelling after she removed her dentures in the evening. On examination, she had an increased respiratory rate. There was a large submandibular swelling at the anterior side of her neck. Upon mouth opening, there was a hematoma at the base of her tongue, which extended to both sides of the tonsillar pillars. The patient was intubated with a video laryngoscope due to her worsening respiratory distress. Intravenous vitamin K and fresh frozen plasma were given immediately. The patient was admitted to the ICU for ventilation and observation. The hematoma subsided after 2 days and she was discharged well.

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“…Previous reports do not seem to favour endotracheal intubation, with only two previous successful cases, 6,8 and examples of failed attempts due to obstructive effects of the haematoma. 1,4,5 The introduction of an endotracheal tube carries the risk of causing further haematomas in the larynx. 7 At least seven of the previously described reports managed such patients by means of cricothyroidotomy or tracheostomy, 1 -6 and one author advocates early tracheostomy as the preferred method of management.…”

Section: Discussionmentioning

confidence: 99%

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

et al. 2006

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Airway obstruction secondary to bleeding from warfarin therapy is difficult to manage and uncommon but has been previously described. Previous reports have emphasized the need for reversal of therapy using vitamin K and fresh frozen plasma (FFP). Where a definitive airway has been required, cricothyroidotomy or tracheostomy seem to have been favoured. Several authors have reported failed attempts at endotracheal intubation due to the obstructive effects of a sublingual haematoma. We report here a case which illustrates how endotracheal intubation can be used successfully under the right conditions. It also highlights the superiority of prothrombin complex concentrate over FFP in achieving rapid reversal of abnormal international normalized ratio in the emergency situation.

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Pulmonary Edema Secondary to Warfarin-Induced Sublingual and Laryngeal Hematoma

Cited by 14 publications

References 0 publications

Upper airway hematoma secondary to warfarin therapy: A systematic review of reported cases

Upper airway hematoma secondary to warfarin therapy: A systematic review of reported cases

Denture Induced Submandibular Hematoma in a Patient on Warfarin

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

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