Upper-airway obstruction as a complication of oral anticoagulation therapy

Duong, Tong C.; Burtch, Gordon D.; Shatney, Clayton H.

doi:10.1097/00003246-198609000-00016

Cited by 40 publications

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“…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

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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.

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Section: Discussionmentioning

confidence: 99%

Spontaneous Uvula, Soft Palate and Pharynx Hematoma

Günizi¹

2015

JOENTR

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“…Initially it is important to assess, and if necessary, secure the airway. If anticoagulation is the cause this needs to be reversed [1]. …”

Section: Discussionmentioning

confidence: 99%

“…In previous cases, reversal of anticoagulant therapy has often been carried out with fresh frozen plasma (FFP) in combination with vitamin K [1,2]. Beriplex ® prothrombin complex concentrate was used in our patient's case.…”

Section: Discussionmentioning

confidence: 99%

“…Such complications usually appear in the genitourinary, gastrointestinal, retroperitoneal and intracranial areas, with few reports involving the upper airway. In relation to these cases, airway compromise often stems from retropharyngeal and laryngeal hematomas, and only occasional reports state sublingual hematoma formation as a result of deficient coagulation [1,2]. …”

Section: Introductionmentioning

confidence: 99%

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Massive sublingual hematoma secondary to anticoagulant therapy complicated by a traumatic denture: a case report

et al. 2012

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IntroductionSublingual hematoma secondary to excessive anticoagulation is a rare but potentially fatal condition, and few cases have been documented in the literature.Case presentationWe report the case of a 73-year-old Caucasian woman who attended our Accident and Emergency department with massive sublingual hematoma causing superior displacement of the tongue. The condition was found to be the result of an elevated international normalized ratio, further complicated by a traumatic mandibular denture.ConclusionsIn summary, we recommend the immediate reversal of anticoagulation therapy on admission of patients with severe sublingual hematoma. We further advise surgical decompression/drainage if required and to continue meticulous monitoring. In all cases of early recognition of sublingual hematoma, prompt medical treatment and continuous clinical monitoring is essential, and may prevent the need for a surgical airway procedure.

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“…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].…”

Section: Dr Banmentioning

confidence: 99%

A 67-year-old man with anterior neck swelling

et al. 2009

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Dr. Carlo Rosen: The patient was a 67-year-old man who just got off an airplane from Florida complaining of anterior neck swelling that developed either late the night prior or early that morning. He was concerned enough in Florida that he wanted to come to Boston, where all his doctors were, so he obtained a flight to Boston with his wife. He said over the past few hours, the swelling had gotten worse, and that he had developed a little bit of a hoarse voice. Initially he got put into one of our resuscitation rooms, and a quick history revealed that he was on coumadin for atrial fibrillation. He also denied fevers, denied any history of anything like this happening in the past, denied rash or any pain or discomfort anywhere else, and was able to give a full history by himself. Other past medical history was significant for a previous carotid stent and asthma. He did say he had allergies to shellfish, associated with a rash, and took no other medications but the coumadin. Are there any questions?Dr. Richard Wolfe: How many hours passed from the onset of his symptoms to the point he presented?Dr. C. Rosen: He was vague about the exact timing. He probably had symptoms the night before starting with the swelling, and the voice change happened over the past few hours. Dr. Wolfe: You saw him roughly at what time?Dr. C. Rosen: Probably early afternoon. He took a taxi from the airport to the Emergency Department (ED).Dr. C. Rosen: To me there were two worrisome parts to the history. One was the swelling which had gone on for probably 18 h. The second, and more concerning, was the voice change, which he said had occurred over 2-3 h. Dr. Wolfe: I am not clear why he was taking coumadin. There was absolutely no history of any trauma, correct? Dr. C. Rosen: There was no history of trauma. He was on coumadin for atrial fibrillation, and said he had been taking his usual dose. On physical examination the vitals were: temperature of 36.5°C (97.7°F,) pulse 117 beats per minute, blood pressure 156/88 torr., respirations 25 breaths per minute, and oxygen saturation 99% on room air. He looked very comfortable. The only alarming thing about the examination was he had a slightly hoarse voice. I think we picked up the voice changes more than he himself or his wife did. He clearly had anterior submandibular neck swelling from the whole anterior mid to upper part of the neck. He had some tongue elevation and some sublingual ecchymosis; it was not woody, but it was definitely feeling full. The rest of the examination was normal. He was totally appropriate and wide awake and not in a whole lot of distress.

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Upper-airway obstruction as a complication of oral anticoagulation therapy

Cited by 40 publications

References 0 publications

Spontaneous Uvula, Soft Palate and Pharynx Hematoma

Spontaneous Uvula, Soft Palate and Pharynx Hematoma

Massive sublingual hematoma secondary to anticoagulant therapy complicated by a traumatic denture: a case report

A 67-year-old man with anterior neck swelling

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