Sublingual Hematoma After Usual Warfarin Dose

Moraes, Hécio Henrique Araújo de; Santos, Thiago de Santana; Camargo, Igor Batista; Vasconcellos, Ricardo José de Holanda

doi:10.1097/scs.0b013e3182997ca0

Cited by 8 publications

(5 citation statements)

References 6 publications

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“…The mean dose of warfarin taken by the patients was 5.34 ± 2.58 mg. The indications for warfarin were as follows: Mechanical valves (MVs) ( n = 11, 29.73%),[ 2 4 5 6 7 8 9 10 11 ] atrial fibrillation (AF) ( n = 10, 27.03%),[ 3 12 13 14 15 16 17 18 19 20 ] venous thromboembolism (VTE) ( n = 9, 24.32%),[ 1 21 22 23 24 25 26 27 28 ] chronic thrombophlebitis ( n = 2, 5.41%),[ 29 30 ] and polycythemia vera ( n = 1, 2.70%). [ 31 ] The indication of anticoagulation was unclear in four cases.…”

Section: Resultsmentioning

confidence: 99%

“…Conservative management with vitamin K, fresh frozen plasma (FFP), or prothrombin complex concentrate (PCC) was instituted in 18 (48.65%)[ 2 3 6 8 9 11 12 13 14 15 17 18 19 20 27 32 ] cases Table 2 . Cricothryrotomy was performed in two (5.41%) cases,[ 21 23 ] tracheotomy in 12 (32.43%) cases,[ 1 4 5 11 21 22 23 24 25 26 31 33 ] endotracheal intubation in five (13.51%) cases,[ 1 4 10 22 28 ] nasotracheal intubation in four (10.81%) cases,[ 5 7 16 29 ] and surgical evacuation of hematoma in two (5.41%) cases.…”

Section: Resultsmentioning

confidence: 99%

“…Most cases did not mention whether warfarin was restarted or not during the follow-up period. It was switched to aspirin in five cases[ 17 18 22 24 26 ] and restarted immediately after resolution of the symptoms in three cases;[ 8 11 27 ] however, the dose at which it was restarted was not clear.…”

Section: Resultsmentioning

confidence: 99%

“…Hence, in mild cases with no airway compromise, our study favors medical therapy with reversal of the coagulopathy with vitamin K and FFP or PCC preferably in an ICU setting. [ 1 13 18 ] The recommended dose of FFP and PCC is 4 units/kg with INR greater than 1.5 and 50 units/kg with INR greater than 6, respectively. [ 13 ] Although surgical drainage has been described,[ 36 ] it is not warranted in most cases as it carries the risk of increasing soft tissue edema and airway compromise.…”

Section: Discussionmentioning

confidence: 99%

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Upper airway hematoma secondary to warfarin therapy: A systematic review of reported cases

et al. 2015

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Upper airway hematoma (UAH) is a rare but life-threatening complication of oral anticoagulants requiring early recognition. However, no consensus exists regarding the best approach to treatment. We therefore, sought to systematically review the published literature on UAH to elaborate its demographic and clinical characteristics, treatment, complications, and outcomes. A systematic electronic search of PubMed and EMBASE for case reports, case series, and related articles of UAH related to warfarin published from inception (November 1950) to March 2015 was carried out. Categorical variables were expressed as percentage and continuous variables as mean ± standard deviation (SD). Statistical analysis was done using Statistical Package for the Social Sciences (SPSS) version 20.0. All cases were reported to have UAH as a complication of anticoagulation therapy with warfarin. Demographic and clinical characteristics, treatment, complications and outcomes of UAH were studied. Thirty-eight cases of UAH were identified from 34 reports in the literature. No gender preponderance (male = 52.78%) was seen and the average age of presentation was 60.11 ± 12.50 years. Dysphagia, sore throat, and neck swelling were the most common symptoms and the mean international normalized ratio (INR)at presentation was 8.07 ± 4.04. Most cases had sublingual hematoma (66.57%) followed by retropharyngeal hematoma (27.03%). Of the cases, 48.65% were managed conservatively while the rest underwent either cricothyrotomy or intubation with the time to resolution being 7.69 ± 5.44 days. UAH is a rare butpotentially serious complication of warfarin therapy. It is more common in the elderly population with supratherapeutic INR; inciting events were present in many cases. Overall, it has a good prognosis with significant morbidity present only if concomitant respiratory compromise is present. Reversal of anticoagulation with low threshold for artificial airway placement in the event of airway compromise leads to a favorable outcome in most cases.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Upper airway hematoma secondary to warfarin therapy: A systematic review of reported cases

et al. 2015

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“…Excessive doses can lead to an imbalance in the coagulation cascade and consequent local and systemic hemorrhage at invisible sites of difficult access, including the brain and joints, putting the patient's life at risk [7]. Sublingual and retropharyngeal hematomas are uncommon [5,6,8]. Bleeding in these regions is lifethreatening because it can obstruct the upper airways [5,8] and can cause brain damage due to anoxia and death if not treated in a timely manner [9].…”

Section: Discussionmentioning

confidence: 99%

Anticoagulant-induced oral bleeding

Costa¹,

Kaminagakura²

2017

BDS

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Warfarin is an anticoagulant used to prevent thrombosis, cardiac arrhythmias, atrial fibrillation, and recurrence of pulmonary embolism. A 69-year-old male patient reported episodes of four heart attacks, stroke, pulmonary emphysema, varicose veins, thyroid dysfunction, and a history of angioplasty. They use daily dose of 5 mg. Intraoral clinical examination revealed a bleeding nodular lesion of purple color with irregular borders and a smooth surface. The prothrombin time was 68.9 seconds, activity was 10%, and the international normalized ratio (INR) was 8.26. Based on these results, the patient received a single dose of 2.5 mg vitamin K via subcutaneous route. The final diagnosis was oral anticoagulant-induced lesions. Clinicians should be familiar with the side effects of anticoagulants, which are rare in the oral cavity, but can be life-threatening if diagnosed late or inaccurately, especially in older patients that often use many drugs.KeywordsAnticoagulant; Hemorrhage; Warfarin; Mouth.

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