Upper Airway Obstruction as a Complication of Oral Anticoagulation Therapy

Rosenbaum, Lewis; Thurman, Peter; Krantz, Sanford B.

doi:10.1001/archinte.1979.03630470061019

Cited by 65 publications

(20 citation statements)

References 10 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Hematoma development was attributed to the trauma during laryngeal intubation and uvulectomy was performed in the patient. In the literature, some researchers state that routine tracheotomy/cricothyrotomy should be performed in patients with hemorrhage and hematoma that may cause airway obstruction [13][14][15]. However, prophylactic intubation may increase the hematoma development due to existing hemorrhagic diathesis, and compromise the airway.…”

Section: Discussionmentioning

confidence: 99%

Spontaneous Uvula, Soft Palate and Pharynx Hematoma

Günizi¹

2015

JOENTR

View full text Add to dashboard Cite

Eighty year-old male patient presented to our emergency department with dysphagia and dyspnea. The patient was diagnosed with chronic renal failure 12 years ago and had been receiving hemodialysis. Last hemodialysis with heparin was received 8 hours ago and the patient started to get the feeling of something stuck in the throat and had dyspnea. In examination, a hematoma on uvula and soft palate that significantly obstructed oropharynx, and 2x3 cm submucosal hematoma on posterior wall of oropharynx were observed (Figure 1). In fiberoptic laryngoscopy, larynx was normal and rima glottis was not obstructed. In anamnesis, there was no dental intervention or trauma history. Oxygen saturation was determined as 98%, body temperature was normal. Due to high saturation and open air passage, emergency tracheotomy or laryngeal intubation was not considered. In laboratory analysis, prothtrombin time (PT) was 18.3 seconds, active partial thromboplastin time (APTT) was immeasurably long (>200). Hemoglobin was 10.6, leukocyte count was 7190, thrombocyte count was 225.000, BUN was 31 mg/dL, creatinine was 5.2 mg/dL , Na was 140 mEq/L, K was 4.7 mEq/L. Due to normal oxygen saturation, emergency surgery was not considered. The patient was transferrred to the ward due to high APTT, and fresh frozen plasma replacement was performed. Parenteral steroid and antibiotic therapy were initiated. Dialysis without anticoagulant was performed during follow-up period. Hematomas on uvula, soft palate and oropharynx were resolved. Physical examination and laboratory findings of the patient recovered expeditiously and APTT value was decreased to therapeutic levels, so the patient was discharged and advised to come back for policlinic controls. Submit Manuscript AbstractIn patients who receive hemodialysis, incidence of bleeding disorders is increased and the complications include various systemic bleeding. In these patients, an important factor that increases the severity of hemorrhage is chronic systemic heparinization. Hemorrhage that involves respiratory tract causes a severe clinical manifestation due to the risk of airway obstruction. Hematoma that involves uvula, soft palate and pharynx is a rare complication. Uvula hematomas which develop after trauma or thrombolytic therapy have been reported in the literature [1][2][3][4]. Here, we present a case receiving hemodialysis for 12 years and has spontaneous submucosal hematomas that involves uvula, soft palate and posterior wall of oropharynx as a rare but serious complication due to heparin that involves uvula, soft palate and posterior wall of oropharynx.

show abstract

Section: Discussionmentioning

confidence: 99%

Spontaneous Uvula, Soft Palate and Pharynx Hematoma

Günizi¹

2015

JOENTR

View full text Add to dashboard Cite

show abstract

“…Antikoagülan tedavi sonrası internal ve eksternal kanama %2-5,2 oranında görülmektedir (2)(3)(4)(5). En sık deri, kafa içi, genitoüriner ve gastrointestinal kanama görülür (6, 7).…”

Section: Discussionunclassified

Pharyngeal Hematoma Secondary to Anticoagulant Therapy: Case Report

Kaya¹,

Ceylan²,

Kocak³

et al. 2012

Turk J Anesth Reanim

View full text Add to dashboard Cite

Hematomas secondary to anticoagulant therapy, inducing upper airway obstruction, are mostly located in the retropharyngeal, sublingual, submandibular and, rarely, laryngeal space. Most are managed conservatively but sometimes endotracheal intubation and emergency tracheotomy are necessary. We report a case of asphyxia due to a pharyngeal hematoma secondary to warfarin use, admitted to the emergency service with cardiopulmonary arrest.A 48 year-old woman presented at the emergency service with sore throat and difficulty in swallowing in the morning. After evaluation of the oropharynx, she was referred to the ear-nose throat clinic. However, on the same day, she presented at the emergency service with cardiopulmonary arrest. Direct laryngoscopy revealed a posterior pharyngeal mass or hematoma. Repeated intubation attempts failed. Despite the application of a laryngeal mask, she could not be ventilated and an emergency tracheostomy was performed. In her medical history, it was learned that she was taking warfarin for mitral stenosis. INR values were unmeasurably high. Fresh frozen plasma and vitamin K treatment were started. A computed tomography scan of the neck and cranium revealed extensive cerebral edema and a lesion in the pharynx, not distinguishable between bleeding and tumor and almost completely obstructing the airway. On the second day, her renal function deteriorated and she developed hypernatremia. The patient died due to multiorgan failure on the 5 th day.In patients using anticoagulants and presenting with symptoms like sore throat, odynophagia, dysphagia and hoarseness, pharyngeal hematoma should be excluded. Early diagnosis increases the success of conservative treatment and can be life-saving by preventing prolonged airway attempts.

show abstract

“…Numerous sites have been described including genitourinary, gastrointestinal tract, skin, central nervous system & nose. Upper airway obstruction secondary to anticoagulants can occur from acute laryngeal haematomas [1] or from spontaneous bleeding into retropharyngeal and submandibular (sublingual and submaxillary) spaces [2,3]. The diagnosis is elusive and absence of infectious features makes the severity of the process less obvious.…”

Section: Discussionmentioning

confidence: 99%

“…Management of these cases involves correction of the underlying coagulopathy as early as possible to limit further extension of haemorrhage so as to prevent the need of an artifi cial airway by tracheostomy or intubation [2].Rapid correction of coagulopathy includes discontinuation of anticoagulant therapy followed by administration of fresh frozen plasma/prothrombin complex concentrate or parenteral Vit K [6]. Prophylactic intubation or tracheostomy in these patients is hazardous and diffi cult due to additional bleeding occurring during airway manipulation and also altered anatomy resulting from a large haematoma [2].Correction of the underlying coagulopathy will limit further extension of haemorrhage and prevent need for intubation or tracheostomy.…”

Section: Discussionmentioning

confidence: 99%

“…Prophylactic intubation or tracheostomy in these patients is hazardous and diffi cult due to additional bleeding occurring during airway manipulation and also altered anatomy resulting from a large haematoma [2].Correction of the underlying coagulopathy will limit further extension of haemorrhage and prevent need for intubation or tracheostomy. Surgical drainage of the haematoma is not indicated and resolution usually occurs within a few days once the coagulation patterns are normalized [6].…”

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation