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

Abstract

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.

Successful intracavitary tissue plasminogen activator treatment of gastrocnemius intramuscular hematoma in a patient following anticoagulant therapy with warfarin

“…Because of the narrow therapeutic range, warfarin may cause severe bleeding that can be life-threatening in addition to its antithrombotic benefits. Generally, the bleeding occurs in the genitourinary, gastrointestinal and spinal systems, as well as the intracranial region and skin [2]. There are reports in the literature of retropharyngeal, rectus sheath, spinal and oesophageal hematomas as rare complications of the anticoagulation therapy [3][4][5].…”

Sublingual and Supraglottic Haemorrhage as a Complication of Warfarin Therapy

“…2 There is no consensus on the use of systemic steroids or prophylactic antibiotics in patients with upper airway haemorrhage. [2][3][4][5] Antibiotics can be used for abscess formation and when non-resolving haematoma is observed as late complications. 3,5 Our first patient received 10 mg vitamin K1 and 4 unit fresh frozen plasma intravenously.…”

“…The upper airway haemorrhage is clinically important because it may lead to the development of a life threatening upper airway obstruction. [2][3][4][5][6] Presenting s y m p t o m s i n c l u d e s o r e t h r o a t , d y s p h o n i a , odynophagia, dysphagia, hoarseness, drooling, respiratory distress, swelling or bruising of the neck. [2][3][4][5] Optical nasopharyngolaryngoscopy, lateral radiograph of the cervical spine, and computed tomography of the neck and mediastinum can be used to determine the site and extent of haematoma, and its relation to other structures within the neck.…”

“…1 Haemorrhage is the most common and serious complication of anticoagulation therapy, and is commonly observed in gastrointestinal tracts, urinary tracts, central nervous system, subcutaneous tissue, skin, nose, penis, and retroperitoneum. [2][3][4][5] Although upper airway haemorrhage is rare, it is a clinically serious condition as the development of upper airway obstruction may be life threatening. [2][3][4][5][6] We reported two cases with sublingual and supraglottic haemorrhage that developed during oral anticoagulation therapy and the related literature was reviewed.…”

A 67-year-old man with anterior neck swelling

“…Wolfe: I actually pulled the very limited literature on this, there may be about 12 cases reported of similar hematomas with potential airway issues [1][2][3][4][5][6][7][8][9][10]. In the reports, a variety of approaches were used including endotracheal intubation [2,5].…”