Successful management of warfarin-exacerbated diffuse alveolar hemorrhage using an extracorporeal membrane oxygenation

Abstract

Although diffuse alveolar hemorrhage complicating warfarin therapy is rare, it generally has a worsening clinical course and can be a life threatening condition. A 56-year-old male who had undergone a pulmonary lobectomy for lung cancer 2 years before had received warfarin for about 5 months due to pulmonary vein thrombosis. The patient presented with severe dyspnea and had prolonged anticoagulation values. Chest X-ray and computed tomography revealed diffuse pulmonary consolidations, and bronchoalveolar lavage demonstrated diffuse alveolar hemorrhage. The reversal of anticoagulation was initiated, and extracorporeal membrane oxygenation was performed for refractory respiratory failure that did not improve despite maximal mechanical ventilatory support. The diffuse alveolar infiltrations resolved after 5 days, and we successfully weaned off both extracorporeal membrane oxygenation and mechanical ventilation. Herein we report the detailed course of a case that was successfully treated with extracorporeal membrane oxygenation as a bridge-to-recovery for warfarin- exacerbated diffuse alveolar hemorrhage.

Extracorporeal membrane oxygenation without systemic anticoagulation: a case-series in challenging conditions

“…A group of polytraumatic patients, affected by bleeding shock, was successfully treated by ECMO with the administration of only an initial bolus of heparin without any subsequent anticoagulant infusion (21). Furthermore, in selected cases, ECMO has been successfully positioned completely even without anticoagulation therapy at all (22)(23)(24). Incidence of ECMO system malfunction related to clot formation during support without SA appeared highly variable among the previously published experiences.…”

Application of veno-arterial-venous extracorporeal membrane oxygenation in differential hypoxia

“…Recent advances in catheters, bypass circuits, membrane oxygenators, and percutaneous cannulation techniques have made possible to start a closed-chest cardiopulmonary bypass outside of the operating room. Percutaneous cardiopulmonary support has produced varying degrees of success as a therapeutic option in various clinical settings, including cardiac arrest, respiratory failure, and special medical conditions [2][3][4][5].…”