acenocoumarol and Airway-Obstruction

Bleeding complications of oral anticoagulant therapy are not rare. The locations for bleeding are most often gastrointestinal, genitourinary and intracranial. Upper airway obstruction remains one of the reported complications. It is produced in most cases by a retropharyngeal haematoma. On the other hand, sublingual haematoma is exceptional and constitutes a problem to secure patient's airway. We report the case of a 16-year-old patient, admitted tenhours after accidental ingestion of 40mg of Sintrom((R)) with major breathing difficulty, haemoptysis and epistaxis. The endotracheal intubation was performed blindly using an Eschmann candle. This rare complication should be prevented by an adapted clinical and biological monitoring.

Topics: Accidents, Home; Acenocoumarol; Administration, Oral; Adolescent; Airway Obstruction; Anticoagulants; Drug Overdose; Erythrocyte Transfusion; Heart Valve Prosthesis; Hematoma; Humans; Intubation, Intratracheal; Male; Mouth Floor; Plasma

The case-histories of three patients treated with acenocumarol attended urgently because of sudden onset dyspnea and dysphonia an presented. Endoscopic and radiologic studies revealed in these patients a laryngeal obstruction by haematomas in a different grade, due to an excess in the effect of anticoagulant therapy, since prothrombine times measured as INR were too high. In one of the cases, the sudden and infrequent evolution associating initialy difficulty of breathing without any inspiratory or phonetic disorder, moved to a late diagnosis with a tragic ending, because it delayed an urgent tracheostomy, which bled profusely. It was a patient with a defective anticoagulant therapy control and numerous previous haemorrhagic incidents. The not so fulminant pattern in the other two cases allowed its early diagnostic and treatment planning, which included the admission to hospital and withdrawal of the anticoagulant drug and the vigilance of symptoms, up to confirm healing. Haemorrhagic laryngeal complications due to acenocoumarol, though unusual, imply an obvious vital trouble that moves to an urgent therapeutic attitude more or less aggressive. Its clinical suspicion obliges to its early discard.

Topics: Acenocoumarol; Airway Obstruction; Anticoagulants; Dyspnea; Fatal Outcome; Heart Arrest; Hematoma; Humans; International Normalized Ratio; Laryngeal Diseases; Male; Middle Aged; Voice Disorders