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DOI QR Code

Severe Airway Obstruction due to Massive Retropharyngeal Hematoma in a Warfarin-Taking Patient with a Normal International Normalized Ratio

  • Cho, Hyun Young (Department of Emergency Medicine, Dankook University Hospital, College of Medicine, Dankook University) ;
  • Kim, Hyung Il (Department of Emergency Medicine, Dankook University Hospital, College of Medicine, Dankook University)
  • 투고 : 2020.07.20
  • 심사 : 2020.09.03
  • 발행 : 2021.03.30

초록

Warfarin is used as part of the treatment of various diseases, and laboratory monitoring of its effects is required. Airway hematoma secondary to warfarin is rare, but can be fatal because of potential airway obstruction. Rapid definitive airway establishment is crucial if airway obstruction is suspected. This complication is more likely to occur in those with elevated coagulation laboratory values. However, we experienced a patient in whom a massive retropharyngeal hematoma caused airway obstruction after a non-severe motor vehicle collision. The patient had been taking warfarin, and had coagulation parameter values within the normal ranges. A major fracture or hemorrhage was not anticipated. Upon examination, a massive retropharyngeal hematoma was noted. Orotracheal intubation failed due to an airway obstruction. Emergency tracheostomy and an operation for hematoma removal were performed. Physicians must always consider the possibility of airway hematoma in warfarin-taking patients with normal coagulation values regardless of the severity of mechanism of injury.

키워드

참고문헌

  1. Samuel G. Deep venous thrombosis and pulmonary thromboembolism. In: Dennis K, Stephen H, Larry J, Anthony F, Dan L, Joseph L, eds. Harrison's principles of internal medicine. 19th ed. New York:McGraw Hill; 2015:1631-7.
  2. Garcia D, Crowther MA, Ageno W. Practical management of coagulopathy associated with warfarin. BMJ 2010;340:c1813. https://doi.org/10.1136/bmj.c1813
  3. Garcia D, Ageno W, Bussey H, Eikelboom J, Margaglione M, Marongiu F, et al. Prevention and treatment of bleeding complications in patients receiving vitamin K antagonists, part 1: prevention. Am J Hematol 2009;84:579-83. https://doi.org/10.1002/ajh.21470
  4. Karmacharya P, Pathak R, Ghimire S, Shrestha P, Ghimire S, Poudel DR, et al. Upper airway hematoma secondary to warfarin therapy: a systematic review of reported cases. N Am J Med Sci 2015;7:494-502. https://doi.org/10.4103/1947-2714.170606
  5. Hatzakorzian R, Shan WL, Backman SB. Epiglottic hematoma: a rare occurrence after tracheal intubation. Can J Anaesth 2006;53:526-7. https://doi.org/10.1007/BF03022630
  6. Cohen AF, Warman SP. Upper airway obstruction secondary to warfarin-induced sublingual hematoma. Arch Otolaryngol Head Neck Surg 1989;115:718-20. https://doi.org/10.1001/archotol.1989.01860300072020
  7. Lee M, Berger HW, Granada MG. Acute upper airway obstruction. Sodium warfarin-induced hemorrhage into the base of the tongue and epiglottis. Chest 1980;77:454-5. https://doi.org/10.1378/chest.77.3.454
  8. Gupta MK, McClymont LG, El-Hakim H. Case of sublingual hematoma threatening airway obstruction. Med Sci Monit 2003;9:CS95-7.
  9. Murray JM, Blunnie WP. Acute upper airway obstruction following sub-lingual haematoma. Ir Med J 1983;76:458.
  10. Brown I, Kleinman B. Epiglottic hematoma leading to airway obstruction after general anesthesia. J Clin Anesth 2002;14:34-5. https://doi.org/10.1016/S0952-8180(01)00349-X
  11. Bapat VN, Brown K, Nakas A, Shabbo F. Retropharyngeal hematoma--a rare complication of anticoagulant therapy. Eur J Cardiothorac Surg 2002;21:117-8. https://doi.org/10.1016/S1010-7940(01)01070-3
  12. Puri A, Nusrath MA, Harinathan D, Lyall J. Massive sublingual hematoma secondary to anticoagulant therapy complicated by a traumatic denture: a case report. J Med Case Rep 2012;6:105. https://doi.org/10.1186/1752-1947-6-105
  13. Ito SM, Yamanashi Y, Takada T, Suzuki H. Clinical importance of drug-drug interaction between warfarin and prednisolone and its potential mechanism in relation to the Niemann-Pick C1-like 1-mediated pathway. Circ J 2019;83:471-80. https://doi.org/10.1253/circj.CJ-18-0807
  14. Peng TR, Lee LL, Wu TW. Interactions between warfarin and prednisolone: a case report. Am J Ther 2017;24:e494. https://doi.org/10.1097/MJT.0000000000000530