Airway obstruction in a man with warfarin-induced sublingual and pharyngeal haematomas

Gastrointestinal, genitourinary and intracranial bleeding are common complications of warfarin therapy. However, airway haematomas can occur in patients with supratherapeutic International Normalised Ratio. The involvement of the airway should be suspected in patients who present with dysphagia, drooling, dysphonia and inability to speak. Conservative management is often sufficient, but a definitive airway, such as endotracheal intubation or a surgical airway, may sometimes be required.We present the case of a man in his early 50s who had a haematoma of the hypopharynx causing airway obstruction that was successfully treated with an emergency tracheostomy. We discuss the current guidelines on difficult airway management and the role of a multidisciplinary team in managing imminent airway obstruction.