acenocoumarol and Laryngeal-Diseases

Topics: Acenocoumarol; Amino Acid Substitution; Anticoagulants; Factor IX; Hematoma; Hemothorax; Humans; International Normalized Ratio; Laryngeal Diseases; Male; Middle Aged; Mutation, Missense; Pedigree; Radiography; Vitamin K

Bleeding is the most serious complication of oral anticoagulant therapy used for the prevention of thromboembolic complications. Drug-drug interactions are an important concern, as they may increase drug toxicity and, in the case of anticoagulant therapies, increase the risk of hemorrhage.. An 84-year-old woman presented to the emergency department with a bilateral cervical hematoma and symptoms of upper-airway obstruction that had been increasing for 72 hours, with dyspnea and difficulty speaking developing in the previous 24 hours. Transnasal fiberoptic laryngoscopy revealed a significant laryngeal hematoma, as well as a hematoma on the floor of the mouth and in the tonsil area. Laboratory abnormalities included a prothrombin time < 10%, an international normalized ratio exceeding the laboratory limits, and an activated partial thromboplastin time >120 seconds. The patient had been receiving acenocoumarol 4 mg/d for 10 years for episodes of atrial fibrillation and recurrent deep venous thrombosis. Seventeen days earlier, she had received a prescription for topical econazole lotion 1% to be applied 3 times daily for 1 month to treat a dermatitis affecting 12% of the body surface. The patient was admitted to the intensive care unit for treatment of respiratory failure, where oxygen was delivered by face mask. The coagulation disorders were treated with prothrombin complex concentrate 30 IU/kg IV and vitamin K1 10 mg IV, and values normalized within 36 hours. Surgical evacuation of the laryngeal hematoma was not necessary. After 48 hours, improvement in the patient's respiratory symptoms allowed transfer to the ear, nose, and throat unit, where daily endoscopic examination was performed. Aspirin was substituted for acenocoumarol, and the patient returned home after 10 days without sequelae. Based on a Naranjo score of 7, this episode was probably related to an interaction between acenocoumarol and econazole.. This report describes a case of a probable interaction between topical econazole lotion 1% and acenocoumarol that resulted in overanticoagulation and a life-threatening laryngeal hematoma in this elderly patient.

Topics: Acenocoumarol; Administration, Topical; Aged, 80 and over; Anticoagulants; Antifungal Agents; Aspirin; Blood Coagulation Disorders; Drug Interactions; Dyspnea; Econazole; Female; Hematoma; Humans; Laryngeal Diseases; Laryngoscopy; Platelet Aggregation Inhibitors; Prothrombin

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

A case is presented of spontaneous haemorrhage into the floor of the mouth occurring in a patient receiving anticoagulants. Spread of interstitial haematoma to the submucosal tissues of the pharynx and larynx caused respiratory embarrassment necessitating a tracheostomy. The genesis and management of such a problem are discussed, and it can be appreciated that close co-operation between the otolaryngologist, haematologist and anaesthetist is essential.

Topics: Acenocoumarol; Adult; Anticoagulants; Asphyxia; Female; Hematoma; Humans; Laryngeal Diseases; Oral Hemorrhage; Pharyngeal Diseases; Tracheotomy