warfarin and Laryngeal-Diseases

A 67-year-old man was found dead, at his home. On external examination, we found a voluminous purplish black ecchymosis of the anterior neck area. On internal examination, we found a voluminous epiglottis hematoma completely obstructing the upper airway. It was associated with other sites of intra-abdominal hemorrhage. Toxicological studies revealed the presence of warfarin at a concentration of 8.4 mg/L in peripheral blood, which supposes an INR well above 4.5. To conclude, we supposed death was due to asphyxia secondary to a spontaneous epiglottic hematoma caused by a high blood concentration of warfarin. Hemorrhage in the epiglottis is very rare. To our knowledge, our patient is the only case of "sudden death" reported with spontaneous epiglottic hematoma due to high blood concentration of warfarin. In forensic practice, an anterior neck ecchymosis, without trauma, may suggest hemorrhage into soft airway tissues. Pathology findings make it possible to exclude exogenous trauma.

Topics: Aged; Airway Obstruction; Anticoagulants; Asphyxia; Death, Sudden; Ecchymosis; Hematoma; Humans; Laryngeal Diseases; Male; Warfarin

Topics: Anticoagulants; Epiglottis; Hematoma; Humans; Laryngeal Diseases; Male; Middle Aged; Tomography, X-Ray Computed; Vocal Cords; Warfarin

Anticoagulation with warfarin is commonly used for prevention of thromboembolic events in patients with atrial fibrillation. Bleeding is the main side effect of anticoagulation. We report the case of a 66-year-old man who developed two spontaneous synchronous upper airway haematomas while on warfarin therapy. To our knowledge, this is the first reported case of a sublingual haematoma presenting simultaneously with supraglottic laryngeal haematomas. Upper airway haematomas are rare in the absence of a history of trauma but need to be urgently assessed due to their life-threatening potential. Clinicians should be aware of the possibility of haematomas involving the upper airway in patients on anticoagulant therapy, particularly if complaining of red flag symptoms such as acute onset dysphonia, odynophagia or airway/breathing difficulties.

Topics: Aged; Airway Obstruction; Atrial Fibrillation; Hematoma; Humans; Laryngeal Diseases; Male; Mouth Floor; Warfarin

Our aim was to review the safety of percutaneous injection laryngoplasty using bovine crosslinked collagen, focusing specifically on two often-stated concerns: injecting patients who are taking the anticoagulant medication warfarin, and injecting patients without prior skin hypersensitivity testing.. Retrospective chart review of injection laryngoplasty performed between 1997 and 2006 at the University of California, Los Angeles.. The study group consisted of 895 patients who underwent 1290 injection laryngoplasty procedures. No bleeding complications were noted in 59 patients taking warfarin. No allergic complications were reported in 845 patients who did not undergo skin hypersensitivity testing before injection laryngoplasty.. Percutaneous bovine crosslinked collagen injection laryngoplasty is safe in patients taking warfarin. Skin testing for hypersensitivity does not appear to be necessary before injection.. Patients on warfarin are candidates for injection laryngoplasty without the need to discontinue the medication. Eliminating skin hypersensitivity testing before percutaneous bovine crosslinked collagen injection laryngoplasty allows for a prompt treatment of glottic insufficiency.

Topics: Aged; Animals; Anticoagulants; Biocompatible Materials; Cattle; Collagen; Female; Glottis; Humans; Hypersensitivity; Injections, Intradermal; Laryngeal Diseases; Male; Postoperative Complications; Postoperative Hemorrhage; Prostheses and Implants; Retrospective Studies; Safety; Vocal Cord Paralysis; Voice Disorders; Warfarin

A case of spontaneous, isolated supraglottic haemorrhage in a patient recently started with warfarin sodium treatment is described. The symptoms of sore throat, dysphonia, stridor, dysphagia or a neck swelling in a patient taking anticoagulants should alert the clinician to the possibility of this rare but potentially fatal complication.

Topics: Anticoagulants; Hemorrhage; Humans; Laryngeal Diseases; Male; Middle Aged; Warfarin

Vocal fold hemorrhage can represent a disastrous and potentially career ending injury to a singer or professional voice user. The risk factors of vocal fold hemorrhage, including laryngeal trauma, phonotrauma, aspirin and nonsteroidal antiinflammatories, and hormonal imbalances are well known. We present a case of an opera singer who developed recurrent vocal fold hemorrhage associated with coumadin anticoagulation therapy. This case highlights the importance of the risk of vocal fold hemorrhage to professional singers and professional voice users and offers an alternative to long-term coumadin therapy in this select population.

Topics: Anticoagulants; Atrial Fibrillation; Hemorrhage; Humans; Laryngeal Diseases; Male; Middle Aged; Vocal Cords; Warfarin

Topics: Acute Disease; Aged; Anticoagulants; Epiglottitis; Hematoma; Humans; Laryngeal Diseases; Male; Warfarin

Topics: Aged; Airway Obstruction; Anticoagulants; Female; Hematoma; Humans; Laryngeal Diseases; Male; Pharyngeal Diseases; Warfarin

Topics: Aged; Aged, 80 and over; Airway Obstruction; Glottis; Hematoma; Humans; Laryngeal Diseases; Male; Warfarin

Topics: Aged; Hematoma; Humans; Laryngeal Diseases; Male; Mouth Floor; Pulmonary Edema; Warfarin

Described are the cases of two patients who presented with vocal cord hematomas consequent to poor control of anticoagulation. Both patients presented with hoarseness and cough. One required intubation due to respiratory obstruction. Vocal cord hematomas should be considered in patients who present with upper airway symptoms while anticoagulated.

Topics: Aged; Airway Obstruction; Female; Glycolates; Hematoma; Hoarseness; Humans; Laryngeal Diseases; Male; Middle Aged; Ticrynafen; Vocal Cords; Warfarin