Alveolar hemorrhage associated with warfarin therapy: a case report and literature review

Abstract

A 75-year-old man was admitted to our clinic with the complaints of palpitation, fever, severe dyspnea, dizziness and bloody sputum associated with coughing. Chest radiographs revealed that the lungs were bilaterally infiltrated. A high resolution computed tomographic study of the thorax disclosed diffuse alveolar hemorrhage, of which presence was proved by histopathological study of bronchoalveolar lavage material. The hemorrhage occured at 8th day of 5 mg daily warfarin therapy, which was given for frequent atrial fibrillation attacks was controlled by fresh frozen plasma and vitamin K. Alveolar hemorrhage is difficult to diagnose and has high mortality if the treatment was not started as soon as possible. This is the first report of alveolar hemorrhage caused by 5 mg daily warfarin therapy. We propose that the patient's age, nutritional status, used drugs should be taken into consideration for true management of patients with atrial fibrillation.

Alveolar Hemorrhage Associated with Rivaroxaban: A Case Series

“…We believe that this may be an under-recognized condition as multiple cases were identified in our institution, yet literature reports are rare. There are case reports of alveolar hemorrhage associated with nearly all anticoagulants, including warfarin [12], low molecular weight heparin [13], and apixaban [14]. The patients highlighted in this case series all had underlying conditions that may have predisposed them to the complication of alveolar hemorrhage.…”

A Rare Complication related with Oral Anticoagulant Use: Diffuse Alveolar Hemorrhage (Over 65 Years; Four Case Reports)

“…Subsequently, only a limited number of cases have been presented. (4,14). Therefore, we believe that our series of four cases may contribute the literature regarding this subject.…”

“…In the elderly population, oral anticoagulants are the most commonly used drugs in order to prevent thromboembolic complications. Various bleeding complications may occur during treatment with oral anticoagulants but the development of DAH is quite rare (3,4). The current report presents four cases of patients above the age of 65 who presented to emergency service consecutively due to DAH, which is a rare complication in warfarin associated hemorrhages.…”

A Case of Diffuse Alveolar Hemorrhage Due to Uncontrolled Warfarin Therapy

“…Ayrıca birçok ilaca bağlı olarak da DAH gelişebilir (7). Ancak oral antikoagülan tedavisine bağlı DAH gelişmesi nadirdir (6,8,9). Bizim olgumuzda AF ve iskemik serebrovasküler hastalık nedeniyle warfarin kullanma hikayesi vardı ve INR düzeyi artmıştı.…”

“…DAH kliniğinde erken tanı hayat kurtarıcı olmakla beraber tanı geciktikçe prognoz kötüleşecektir (9,11 (12). DAH mevcut hastalarda olası yandaş kanama komplikasyonları takip edilmelidir.…”