Spontaneous Sublingual Haematoma in a 90-year Old Patient: A Complication of Direct Oral Anticoagulants

Abstract

Sublingual haematoma is a rare complication of anticoagulants and can be life-threatening. As the number of prescribed anticoagulants is increasing, the incidence of complications of these drugs will continue to increase. A report of a sublingual haematoma in an elderly patient with chronic atrial fibrillation treated with edoxban (Lixiana ©, Daiichi Sankyo Europe GmbH, München, Germany) is reported. A 90-year male presented at the emergency department with an obstructed upper airway due to a sublingual haematoma. The patient received tranexamic acid, prothrombin complex, and fresh frozen plasma. After fiberoptic nasal intubation, the patient was monitored in the intensive care unit. After four days, the patient was extubated, and after six days, the swelling resolved completely. Complications of anticoagulants are rare but can be life-threatening. Recognition of an endangered airway and reversing the effects of the anticoagulant are essential. Surgical evacuation of the haematoma could be considered but is not necessary.

Management of bleeding during dental implant surgery using a novel implant with an abbreviated drilling protocol: A clinical report

“…[1][2][3] Some authors recommend withdrawal of oral anticoagulant use for several days prior to the dental procedure, others recommend a reduction of usage until the International Normalized Ratio (INR) value of 1.5 has been attained. [1][2][3] It is well recognized that patients under oral anticoagulant therapy should be treated with local hemostatic measures (collagen plug, cellulose, fibrin glue, tranexamic acid rinses). [1][2][3] Dental extractions and implant surgical procedures may pose a risk to the development of coagulopathy in patients whose regimen of oral anticoagulant therapy is left unchanged.…”

“…[1][2][3] It is well recognized that patients under oral anticoagulant therapy should be treated with local hemostatic measures (collagen plug, cellulose, fibrin glue, tranexamic acid rinses). [1][2][3] Dental extractions and implant surgical procedures may pose a risk to the development of coagulopathy in patients whose regimen of oral anticoagulant therapy is left unchanged. Implant treatment is a widely offered elective dental procedure to treat patients with partial or complete edentulism.…”

“…The appropriate approach to dental surgery in patients on oral anticoagulant therapy in an outpatient setting has been debated in recent times 1–3 . Some authors recommend withdrawal of oral anticoagulant use for several days prior to the dental procedure, others recommend a reduction of usage until the International Normalized Ratio (INR) value of 1.5 has been attained 1–3 .…”

“…The appropriate approach to dental surgery in patients on oral anticoagulant therapy in an outpatient setting has been debated in recent times 1–3 . Some authors recommend withdrawal of oral anticoagulant use for several days prior to the dental procedure, others recommend a reduction of usage until the International Normalized Ratio (INR) value of 1.5 has been attained 1–3 . It is well recognized that patients under oral anticoagulant therapy should be treated with local hemostatic measures (collagen plug, cellulose, fibrin glue, tranexamic acid rinses) 1–3 .…”