Retropharyngeal Hematoma as a Complication of Anticoagulation Therapy

Abstract

Reports in the literature of retropharyngeal hematoma as a complication of anticoagulation therapy are rare. When this complication does occur, it can become life-threatening if the airway is compromised. However, no consensus exists as to which approach—intubation, tracheotomy, or conservative therapy—is best for managing the airway in these cases. We report a case of retropharyngeal hematoma that occurred as a sequela to a trivial blunt trauma in a 48-year-old man who had been undergoing anticoagulation therapy with warfarin. The hematoma had caused airway obstruction, and the patient was hospitalized. He was treated conservatively, and the hematoma slowly resolved over the course of 2 weeks. On the basis of our experience and the findings of our literature review, we suggest that conservative management can be initiated for small nonexpanding hematomas that do not seriously compromise the airway. Securing the airway with intubation or tracheotomy should be reserved for patients who are in serious respiratory distress; the choice between intubation and tracheotomy should be made on an individual basis.

Airway Trauma in a High Patient Volume Academic Cardiac Electrophysiology Laboratory Center

“…3,4,28,29 Thus, anticoagulated patients are at risk of spontaneous hematoma, and even a minor injury caused by any event in the upper airway such as intubation and vigorous oral suctioning could lead to a hematoma. During ablation procedures for AF and any left-sided ablations, the activated clotting times are typically kept in the 350 second range.…”

“…Retropharyngeal, lingual, and epiglottic hematomas have been reported as complications of anticoagulation therapy. 3–6 In the Hospital of University of Pennsylvania, there has been a shift from the use of conscious sedation to general anesthesia for electrophysiology procedures over the past few years. During this time, several cases of airway trauma have been reported and discussed as part of quality improvement.…”

Fatal Spontaneous Retropharyngeal Hematoma with Airway Obstruction in the Setting of Treatment with Dipyridamole

“…Laryngoscopic inspection usually shows signs of pharyngolaryngeal swelling without signs of the source of bleeding, and a tentative diagnosis of infection or tumor is likely to be made . In previous case reports, CT has been used for diagnosing RH . As in the present case, early CT may be useful if cervical swelling is found in an individual with dementia.…”

Acute airway obstruction due to retropharyngeal haematoma caused by a large fish bone in a patient with hypertension caused by a pheochromocytoma

“…Most documented causes of RH have occurred in the context of cervical fractures, violent coughing, ruptured aneurysm, pharyngeal foreign bodies, injury of cervical blood vessels, vomiting, muscular exercise, deep neck infection, haemorrhagic parathyroid adenoma, iatrogenic injury associated with cardiac catheterisation, cerebral angiography and jugular vein cannulation, spontaneous haemorrhagic with or without anticoagulation therapy, flexion and hyperextension of the neck (fall, motor vehicle accident or airbag deployment) with contusion,6 8 14–17 and laceration of the soft tissues and vessels 7. Anticoagulation and coagulopathic states are important risk factors 18 19…”