Life-threatening sublingual hematoma in a severely hemophilic patient with factor VIII inhibitor

Takeuchi, Manabu; Shikimori, Michio; Kaneda, Toshio

doi:10.1016/s0278-2391(86)80038-6

Cited by 15 publications

(9 citation statements)

References 9 publications

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“…6 Congenital and acquired coagulopathies may be related to unique internal bleeding in the lingual/ sublingual tissues and to subsequent respiratory embarrassment. 3,7 Treatment of acute ischemic cerebrovascular episodes and myocardial infarctions with tissue plasminogen activator, aspirin, heparin, or streptokinase has occasionally induced lingual, sublingual, and submandibular hematomas with subsequent airway deterioration. [8][9][10] In addition, chronic prophylactic administration of heparin and warfarin has also precipitated similar spontaneous and metatraumatic life-endangering incidents.…”

mentioning

confidence: 99%

Critical Hemorrhage in the Floor of the Mouth During Implant Placement in the First Mandibular Premolar Position: A Case Report

Kalpidis¹,

Konstantinidis²

2005

Implant Dentistry

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mentioning

confidence: 99%

Critical Hemorrhage in the Floor of the Mouth During Implant Placement in the First Mandibular Premolar Position: A Case Report

Kalpidis¹,

Konstantinidis²

2005

Implant Dentistry

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“…Extensive hemorrhage from the lingual artery may occur following traumatic injury [4][5][6][7]. Hemorrhage into the tongue has been reported after the use of streptokinase, heparin, tissue-type plasminogen activator administration and in hemophilia [6,[8][9][10]. Sublingual hematomas leading to upper airway obstruction have also been reported in patients treated with anticoagulants [2,11].…”

Section: Discussionmentioning

confidence: 99%

“…In most of the cases managed with observation, rapid deterioration of the airway occurred. According to the clinical situation, orotracheal intubation, nasotracheal intubation, cricothyrotomy or tracheostomy was chosen for airway management [2][3][4][5][6][7][8][9][10].…”

Section: Discussionmentioning

confidence: 99%

Lingual hematoma threatening airway obstruction in a patient on oral anticoagulation with warfarin

Özpolat¹,

Yılmaz²,

Yücel³

2007

Blood Coagulation &Amp; Fibrinolysis

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Warfarin sodium is a commonly used oral anticoagulant agent. It has been well documented that, when effective anticoagulant therapy is employed in treating thromboembolic disease, hemorrhage is a possible complication that can be spontaneous without a history of trauma. The numerous sites of bleeding are the genitourinary and gastrointestinal tracts, the central nervous system, the nose (epistaxis), the penis (priapism), the retroperitoneum, wounds (surgical or traumatic), and subcutaneous tissues during warfarin therapy, but the hemorrhage rarely causes bleeding compromising a patient's airway. We report a case of a spontaneous lingual hematoma that developed during oral anticoagulation therapy. This life-threatening complication of warfarin therapy and its successful management without surgery indicates that observation, close monitoring and reversal of anticoagulation can be a reasonable management option.

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“…The patient's low inhibitor titer (8 Bethesda units) probably accounted for her response to this regimen. A case of sublingual hematoma managed with intubation and the administration of an early activated prothrombin complex (Autoplex) has been documented 16 in the oral surgery literature.…”

Section: Commentmentioning

confidence: 99%

Manifestations of Factor VIII Inhibitor in the Head and Neck

DellaCroce¹,

Kountakis²,

Aguilar³

1999

Arch Otolaryngol Head Neck Surg

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Hemophilia A is the most severe of the inherited bleeding disorders. Otolaryngologists are frequently asked to assist in the care of a patient with this disorder who has intractable bleeding from sites in the head and neck. This disorder is transmitted in an X-linked recessive manner and results from factor VIII deficiency. Factor replacement therapy has contributed much to the management of acute bleeding episodes and the prevention of long-term sequelae in patients with hemophilia. A consequence of factor replacement therapy that occurs in as much as 16% of patients is the development of antibodies to the exogenous factor. These antibodies inactivate any supplemental factor VIII, resulting in continued bleeding despite attempts at replacement therapy. This poses an extremely challenging clinical problem because other standard therapies have had limited usefulness. Activated prothrombin complex has been shown to be efficacious in the treatment of patients with inhibitors. This has led to the production of factor VIII inhibitor bypassing activity (FEIBA), which contains activated forms of factors II, VII, IX, and X. The mechanism of action of this preparation remains unknown, but it seems to bypass the need for factor VIII in the clotting cascade. Factor VIII inhibitor bypassing activity is not as effective as factor VIII concentrates in patients with normally responsive hemophilia, and patients with low inhibitor levels may be given larger doses of factor VIII. Disseminated intravascular coagulation is most often mentioned as a potential complication of the administration of factor VIII inhibitor bypassing activity, although it has been rarely reported. Otolaryngologists should be familiar with this clinical phenomenon and understand its implications. Two patients with bleeding diatheses were recently treated at our institution.

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Life-threatening sublingual hematoma in a severely hemophilic patient with factor VIII inhibitor

Cited by 15 publications

References 9 publications

Critical Hemorrhage in the Floor of the Mouth During Implant Placement in the First Mandibular Premolar Position: A Case Report

Critical Hemorrhage in the Floor of the Mouth During Implant Placement in the First Mandibular Premolar Position: A Case Report

Lingual hematoma threatening airway obstruction in a patient on oral anticoagulation with warfarin

Manifestations of Factor VIII Inhibitor in the Head and Neck

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