Abstract
Introduction
In this case report, we aimed to explain the importance of urgent management in the diagnosis and treatment of a patient who developed retropharyngeal hematoma as a result of the toxicity of warfarin he used due to atrial fibrillation.
Case Report
A 76-year-old male patient came to the emergency room with complaints of sore throat, difficulty swallowing, and shortness of breath. At the time of admission of the patient using warfarin due to atrial fibrillation, oropharynx examination revealed normal uvula, hematoma near the right lip mucosa, and stridor was detected in the lung auscultation of the patient whose trachea was deviated to the left.
In the laboratory tests at the time of the patient's admission, INR was: 13.4. The patient was given 10 mg phytomenadione(K1) iv infusion and 80 mg prednisolone iv. 4 units(1000 ml) of FFP(fresh frozen plasma) was requested. The patient who developed respiratory distress was intubated and transferred to intensive care unit.
Conclusion
Warfarin toxicity may rarely cause bleeding in the upper respiratory tract, and if it creates pressure on the respiratory tract, it may pose a serious life-threatening risk.
Keywords
References
- 1)Yaman H, Guven D, Kandis H, Subasi B, Alkan N, Yilmaz S. Sublingual and Supraglottic Haemorrhage as a Complication of Warfarin Therapy. Hong Kong J Emerg Med. 2011;18(3):177-181. Doi:10.1177/102490791101800310.
- 2. Toker I, Duman atilla O, Yesilaras M, Ursavas B. Retropharyngeal Hematoma due to Oral Warfarin Usage. Turk J Emerg Med. 2014;14(4):182-184. doi:10.5505/1304.7361.2014.25594.
- 3.Akça HS, Algın A, Yönak H, Eroğlu SE. Arterial occlusion after cessation of warfarin treatment. Cukurova Med J 2020;45(1):381-2. Doi:10.17826/cumj.650126.
- 4. Betten DP, Jaquint JL. Traumatic Retropharyngeal Hematoma in a Patient Taking Clopidogrel. Case Rep Emerg Med. 2018;2018: 6147473. Doi:10.1155/2018/6147473.
- 5. Deaton JG, Nappe TM. Warfarin Toxicity. In: Stat Pearls. Stat Pearls August 31, 2020. http://www.ncbi.nlm.nih.gov/books/NBK431112/ .
- 6. Park JE, Jeong EK, Kang DH, Jeon SR. Surgical Treatment of a Life-Threatening Large Retropharyngeal Hematoma after Minor Trauma : Two Case Reports and a Literature Review. Journal of Korean Neurosurgical Society. 2015;58(3):304-7. Doi: 10.3340/jkns.2015.58.3.304.
- 7. Akoğlu E, Seyfeli E, Akoğlu S, Karazincir S, Okuyucu S, Dağlı AS. Retropharyngeal hematoma as a complication of anticoagulation therapy. Ear, Nose, & Throat Journal, 2008;87(3):156-9.
Abstract
Giriş
Bu olgu sunumunda atrial fibrilasyon nedeniyle kullandığı varfarinin toksisitesi sonucu retrofaringeal hematom gelişen hastanın, tanı ve tedavisindeki acil yönetimin önemini anlatmayı amaçladık.
Olgu
76 yaşında erkek hasta acil servise boğaz ağrısı, yutkunurken zorlanma, nefes darlığı şikayetiyle geldi. Atrial fibrilasyon nedeniyle varfarin kullanan hastanın fizik muayenesinde boyun sağında şişlik, hematom mevcut idi. Orofarinks bakısında uvula normal, sağ dudak mukozası yakınında hematomu mevcut olan, trakea sola deviye olan hastanın akciğer oskültasyonunda stridor tespit edildi. Hastanın başvurusu anındaki laboratuar tetkiklerinde INR: 13.4 idi. Hastaya 10 mg fitomenadion(K1) iv infüzyon, 80 mg prednizolon iv verildi. TDP(Taze donmuş plazma) 4 ünite(1000 ml) istendi, solunum sıkıntısı derinleşen hasta entübe edildi ve yoğun bakıma sevk edildi.
Sonuç
Varfarin toksisitesi nadiren de olsa üst solunum yolunda kanamaya yol açabilir, solunum yoluna bası oluşturursa ciddi hayati risk oluşturabilir.
Keywords
References
- 1)Yaman H, Guven D, Kandis H, Subasi B, Alkan N, Yilmaz S. Sublingual and Supraglottic Haemorrhage as a Complication of Warfarin Therapy. Hong Kong J Emerg Med. 2011;18(3):177-181. Doi:10.1177/102490791101800310.
- 2. Toker I, Duman atilla O, Yesilaras M, Ursavas B. Retropharyngeal Hematoma due to Oral Warfarin Usage. Turk J Emerg Med. 2014;14(4):182-184. doi:10.5505/1304.7361.2014.25594.
- 3.Akça HS, Algın A, Yönak H, Eroğlu SE. Arterial occlusion after cessation of warfarin treatment. Cukurova Med J 2020;45(1):381-2. Doi:10.17826/cumj.650126.
- 4. Betten DP, Jaquint JL. Traumatic Retropharyngeal Hematoma in a Patient Taking Clopidogrel. Case Rep Emerg Med. 2018;2018: 6147473. Doi:10.1155/2018/6147473.
- 5. Deaton JG, Nappe TM. Warfarin Toxicity. In: Stat Pearls. Stat Pearls August 31, 2020. http://www.ncbi.nlm.nih.gov/books/NBK431112/ .
- 6. Park JE, Jeong EK, Kang DH, Jeon SR. Surgical Treatment of a Life-Threatening Large Retropharyngeal Hematoma after Minor Trauma : Two Case Reports and a Literature Review. Journal of Korean Neurosurgical Society. 2015;58(3):304-7. Doi: 10.3340/jkns.2015.58.3.304.
- 7. Akoğlu E, Seyfeli E, Akoğlu S, Karazincir S, Okuyucu S, Dağlı AS. Retropharyngeal hematoma as a complication of anticoagulation therapy. Ear, Nose, & Throat Journal, 2008;87(3):156-9.
Details
| Primary Language | English |
|---|---|
| Subjects | Clinical Sciences |
| Journal Section | Case Report |
| Authors | |
| Publication Date | December 28, 2020 |
| Submission Date | September 25, 2020 |
| Published in Issue | Year 2020 Volume: 11 Issue: 4 |
