Sublingual hematoma as a rare complication of warfarin therapy in a patient with rheumatic heart disease: a case report

Abstract

Introduction and importance: Warfarin prevents thromboembolic events by acting as a vitamin -K antagonist. Close monitoring with an international normalized ratio (INR) is required to avoid bleeding-related complications. One of its rare complications is sublingual hematoma, with potentially life-threatening conditions such as severe airway obstruction. We present a rare case of sublingual hematoma after warfarin therapy in a patient with rheumatic heart disease (RHD). Case Presentation: We report a case of a 44-year-old female with rheumatic heart disease who developed sublingual hematoma following warfarin therapy. She presented with difficulty swallowing and speaking due to pain and swelling under her tongue. Her INR was elevated. After discontinuing the drug, the patient received fresh frozen plasma and intravenous vitamin K. Her symptoms resolved within 24 hours, and she was discharged without any complications. As per our understanding, this is the first case of sublingual hematoma secondary to warfarin therapy that has been reported in Pakistan. Clinical discussion: Warfarin remains a cornerstone anticoagulant in developing countries despite bleeding risks, with management of complications like sublingual hematoma involving INR normalization and conservative treatment. Timely intervention and monitoring of drug interactions are critical in preventing serious outcomes and reducing mortality associated with warfarin therapy. Conclusion: Warfarin is a commonly prescribed oral anticoagulant for a variety of conditions. Despite being rare, sublingual hematoma should be considered by the treating physician as a potential complication.