Key result
Supratherapeutic warfarin anticoagulation can cause extensive upper airway hematomas, which may be managed conservatively with vitamin K and prothrombin complex concentrate if there is no airway compromise.
Case Report (n=1)
Upper airway hematoma is a rare but potentially fatal complication of warfarin therapy that can be managed conservatively with rapid reversal using vitamin K and PCC if there is no immediate airway compromise.
Case suggests conservative reversal may suffice for stable warfarin-related airway hematoma; hypothesis-generating and should not change practice.
CASE PRESENTATION: A 63-year-old female presented to the emergency department complaining of cough, neck swelling, dysphagia, and dysphonia for two days, with a past medical history of atrial fibrillation managed with warfarin. Investigations revealed a supratherapeutic international normalised ratio (greater than 10). Imaging and endoscopic examination showed an extensive retropharyngeal hematoma with significant mass effect on the airway. DISCUSSION: A rare but potentially fatal complication of warfarin anticoagulation is upper airway hematoma, with violent coughing described as an inciting cause. Signs of airway compromise necessitate specialist consultation and definitive airway management, while mild cases without airway concerns can be managed conservatively with medical anticoagulation reversal.
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Oyedokun et al. (2020) conducted a case report in Upper airway hematoma (n=1). Supratherapeutic warfarin anticoagulation was evaluated. Supratherapeutic warfarin anticoagulation can cause extensive upper airway hematomas, which may be managed conservatively with vitamin K and prothrombin complex concentrate if there is no airway compromise.
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