title: Major bleeding of the upper aerodigestive tract due to oral anticoagulant/antibiotic interactions.
abstract: BACKGROUND
  Although a well-known complication in certain medical specialties, major bleeding due to the interaction between oral anticoagulants and antibiotics has been rarely reported concerning the upper aerodigestive tract. We report three cases of life-threatening bleeding of the upper aerodigestive tract in a context of antibiotic therapy in patients treated with oral anticoagulants.
  
  
  METHODS
  Three male patients under coumadin anticoagulation therapy presented major bleeding in three different contexts (epistaxis, peritonsillar abscess and postoperative course after total laryngectomy). Surgical intervention for hemostasis was required in all cases, with coagulation correction in two. Complications were severe anemia (2/3) and chronic heart failure (1/3).
  
  
  CONCLUSIONS
  Interactions between two drugs commonly used in otolaryngology can result in major bleeding. The goal of this article is to raise practitioners' awareness of a potentially fatal, although rare, complication. We also review the main preventive strategies.
authors.affiliation: Service d'ORL et de chirurgie cervicofaciale, hôpitaux universitaires de Genève, rue Gabrielle-Perret-Gentil 4, 1211 Genève 14, Switzerland. llnisa@yahoo.ca
authors.forename: L
authors.initials: L
authors.lastname: Nisa
authors.forename: K
authors.initials: K
authors.lastname: Nicoucar
authors.forename: R
authors.initials: R
authors.lastname: Giger
mesh_terms: D000284:Administration, Oral; D000368:Aged; D000900:Anti-Bacterial Agents / Q000008:administration & dosage / Q000009:adverse effects* / Q000627:therapeutic use; D000925:Anticoagulants / Q000008:administration & dosage / Q000009:adverse effects* / Q000627:therapeutic use; D004347:Drug Interactions; D004359:Drug Therapy, Combination; D004844:Epistaxis / Q000139:chemically induced; D005500:Follow-Up Studies; D006470:Hemorrhage / Q000139:chemically induced* / Q000188:drug therapy; D006801:Humans; D008297:Male; D008875:Middle Aged; D009302:Nasopharyngeal Diseases / Q000139:chemically induced* / Q000188:drug therapy; D019106:Postoperative Hemorrhage / Q000139:chemically induced; D012307:Risk Factors; D016896:Treatment Outcome; D014859:Warfarin / Q000008:administration & dosage / Q000009:adverse effects* / Q000627:therapeutic use
chemical_list: D000900:Anti-Bacterial Agents; D000925:Anticoagulants; D014859:Warfarin