Key result
Warfarin-associated upper airway hematoma resolves conservatively in ~49% of cases.
Why the study?
Upper airway hematoma is a rare but life-threatening complication of warfarin therapy with no consensus on the best treatment approach.
What are the clinical characteristics, treatments, and outcomes of upper airway hematoma secondary to warfarin therapy?
Systematic Review (n=38)
What are the clinical characteristics, treatments, and outcomes of upper airway hematoma secondary to warfarin therapy?
Upper airway hematoma secondary to warfarin is a rare, serious complication typically presenting with supratherapeutic INR, requiring early recognition and often artificial airway placement.
Clinicians should suspect upper airway hematoma in warfarin patients with neck symptoms and elevated INR; systematic review extends sparse case data with pooled management and resolution metrics.
Upper airway hematoma (UAH) is a rare but life-threatening complication of oral anticoagulants requiring early recognition. However, no consensus exists regarding the best approach to treatment. We therefore, sought to systematically review the published literature on UAH to elaborate its demographic and clinical characteristics, treatment, complications, and outcomes. A systematic electronic search of PubMed and EMBASE for case reports, case series, and related articles of UAH related to warfarin published from inception (November 1950) to March 2015 was carried out. Categorical variables were expressed as percentage and continuous variables as mean ± standard deviation (SD). Statistical analysis was done using Statistical Package for the Social Sciences (SPSS) version 20.0. All cases were reported to have UAH as a complication of anticoagulation therapy with warfarin. Demographic and clinical characteristics, treatment, complications and outcomes of UAH were studied. Thirty-eight cases of UAH were identified from 34 reports in the literature. No gender preponderance (male = 52.78%) was seen and the average age of presentation was 60.11 ± 12.50 years. Dysphagia, sore throat, and neck swelling were the most common symptoms and the mean international normalized ratio (INR)at presentation was 8.07 ± 4.04. Most cases had sublingual hematoma (66.57%) followed by retropharyngeal hematoma (27.03%). Of the cases, 48.65% were managed conservatively while the rest underwent either cricothyrotomy or intubation with the time to resolution being 7.69 ± 5.44 days. UAH is a rare butpotentially serious complication of warfarin therapy. It is more common in the elderly population with supratherapeutic INR; inciting events were present in many cases. Overall, it has a good prognosis with significant morbidity present only if concomitant respiratory compromise is present. Reversal of anticoagulation with low threshold for artificial airway placement in the event of airway compromise leads to a favorable outcome in most cases.
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Karmacharya et al. (2015) conducted a systematic review in Upper airway hematoma secondary to warfarin therapy (n=38). Warfarin therapy was evaluated on Demographic and clinical characteristics, treatment, complications, and outcomes of UAH. Upper airway hematoma secondary to warfarin therapy is a rare complication (mean INR 8.07), with 48.65% of cases managed conservatively and a mean time to resolution of 7.69 days.
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