Management of upper airway obstruction secondary to warfarin therapy: the conservative approach.
Airway obstruction secondary to bleeding from warfarin therapy is difficult to manage and uncommon but has been previously described. Previous reports have emphasized the need for reversal of therapy using vitamin K and fresh frozen plasma (FFP). Where a definitive airway has been required, cricothyroidotomy or tracheostomy seem to have been favoured. Several authors have reported failed attempts at endotracheal intubation due to the obstructive effects of a sublingual haematoma. We report here a case which illustrates how endotracheal intubation can be used successfully under the right conditions. It also highlights the superiority of prothrombin complex concentrate over FFP in achieving rapid reversal of abnormal international normalized ratio in the emergency situation.
Lim
Mingyann
M
Department of Otolaryngology, Great Western Hospital, Swindon, UK. mingyannl@yahoo.com
Chaudhari
Meena
M
Devesa
Pablo M
PM
Waddell
Angus
A
Gupta
Deepak
D
D000369:Aged, 80 and over; D000402:Airway Obstruction / Q000139:chemically induced / Q000628:therapy*; D000925:Anticoagulants / Q000009:adverse effects*; D001779:Blood Coagulation Factors / Q000627:therapeutic use; D003422:Critical Care / Q000379:methods; D006406:Hematoma / Q000139:chemically induced / Q000628:therapy*; D006801:Humans; D007442:Intubation, Intratracheal / Q000379:methods; D008297:Male; D016896:Treatment Outcome; D014859:Warfarin / Q000009:adverse effects*
D000925:Anticoagulants; D001779:Blood Coagulation Factors; C025667:prothrombin complex concentrates; D014859:Warfarin