Diffuse Alveolar Haemorrhage Secondary to Warfarin Therapy for Atrial Fibrillation: a Case Report and Literature Review

Overview

Journal BMJ Case Rep

Specialty General Medicine

Date 2011 Jun 21

PMID 21686645

Citations 9

Authors

Abdelkarim Waness

Tarek Aldabbagh

Mohammed Harakati

Affiliations

Soon will be listed here.

Abstract

Alveolar haemorrhage is a rare and serious medical emergency with many causes. Diffuse alveolar haemorrhage due to warfarin therapy has been rarely reported in the literature. In this paper, we describe the case of 62-year-old woman with a history of chronic atrial fibrillation treated with warfarin, who was admitted to our institution with haemoptysis and dyspnoea. Alveolar haemorrhage was suspected clinically and subsequently confirmed by bronchoscopy. The patient required aggressive treatment with fresh frozen plasma, vitamin K and mechanical ventilation with a successful outcome. We emphasise the need for early diagnosis and fast therapeutic intervention, especially with over-anticoagulation (INR >9), in patients with this rare and potentially lethal condition.

Citing Articles

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References

Thomas J, Jayaprakash K, Misiriya K, Khadar S, Pappachan J . Catastrophic pulmonary alveolar hemorrhage complicating warfarin therapy. J Assoc Physicians India. 2008; 56:34. View

Macri A, Stoica R, Ion I, Danila E, Tanaseanu S . [Wegener granulomatosis with severe alveolar hemorrhagic syndrome]. Pneumologia. 2007; 56(3):137-41. View

Hauser V, Rozek S . Effect of warfarin on the activated partial thromboplastin time. Drug Intell Clin Pharm. 1986; 20(12):964-7. DOI: 10.1177/106002808602001210. View

Green R, Ruoss S, Kraft S, Duncan S, Berry G, Raffin T . Pulmonary capillaritis and alveolar hemorrhage. Update on diagnosis and management. Chest. 1996; 110(5):1305-16. DOI: 10.1378/chest.110.5.1305. View

JAQUES L . Spontaneous hemorrhage with anticoagulants. Circulation. 1962; 25:130-9. DOI: 10.1161/01.cir.25.1.130. View

Potasman I, Michaeli S, Bassan H . [Massive intra-alveolar hemorrhage in chronic idiopathic thrombocytopenic purpura]. Harefuah. 1988; 115(1-2):17-8. View

Boussuges A, Pinet C, Thomas P, Bergmann E, Sainty J, Vervloet D . Haemoptysis after breath-hold diving. Eur Respir J. 1999; 13(3):697-9. DOI: 10.1183/09031936.99.13369799. View

Gallagher H, Kwan J, Jayne D . Pulmonary renal syndrome: a 4-year, single-center experience. Am J Kidney Dis. 2002; 39(1):42-7. DOI: 10.1053/ajkd.2002.29876. View

Maalej S, Drira I, Fennira H, Ben Mefteh R, Bourguiba M, Zidi A . [Idiopathic pulmonary hemosiderosis in adults]. Rev Pneumol Clin. 2005; 61(2):109-11. DOI: 10.1016/s0761-8417(05)84796-0. View

10.

Drew W, FINLEY T, Golde D . Diagnostic lavage and occult pulmonary hemorrhage in thrombocytopenic immunocompromised patients. Am Rev Respir Dis. 1977; 116(2):215-21. DOI: 10.1164/arrd.1977.116.2.215. View

11.

Casadevall J, Alvarez-Sala R, Prados C, Gamallo C, Villamor J . Dissection of ascending aorta. A new cause of alveolar hemorrhage?. J Cardiovasc Surg (Torino). 1994; 35(4):327-8. View

12.

Gallouj K, Brichet A, Lamblin C, Wallaert B . [Pulmonary hemorrhagic syndrome after inhalation of cocaine]. Rev Mal Respir. 1999; 16(4):560-2. View

13.

Carloni A, Piciucchi S, Giannakakis K, Nori G, Zobel B, Poletti V . Diffuse alveolar hemorrhage after leflunomide therapy in a patient with rheumatoid arthritis. J Thorac Imaging. 2008; 23(1):57-9. DOI: 10.1097/RTI.0b013e3181598d40. View

14.

Kearon C, Johnston M, Moffat K, Mcginnis J, Ginsberg J . Effect of warfarin on activated partial thromboplastin time in patients receiving heparin. Arch Intern Med. 1998; 158(10):1140-3. DOI: 10.1001/archinte.158.10.1140. View

15.

de Lassence A, Fleury-Feith J, Escudier E, Beaune J, Bernaudin J, Cordonnier C . Alveolar hemorrhage. Diagnostic criteria and results in 194 immunocompromised hosts. Am J Respir Crit Care Med. 1995; 151(1):157-63. DOI: 10.1164/ajrccm.151.1.7812547. View

16.

FINLEY T, Aronow A, Cosentino A, Golde D . Occult pulmonary hemorrhage in anticoagulated patients. Am Rev Respir Dis. 1975; 112(1):23-9. DOI: 10.1164/arrd.1975.112.1.23. View

17.

Conley M, Patino G, Romick B, Almaleh M, Campbell C, Hawkins K . Abciximab-induced alveolar hemorrhage after percutaneous coronary intervention. Can J Cardiol. 2008; 24(2):149-51. PMC: 2644574. DOI: 10.1016/s0828-282x(08)70573-7. View

18.

Erdogan D, Kocaman O, Oflaz H, Goren T . Alveolar hemorrhage associated with warfarin therapy: a case report and literature review. Int J Cardiovasc Imaging. 2004; 20(2):155-9. DOI: 10.1023/b:caim.0000014101.06445.66. View

19.

Friesecke S, Bohm E, Lorenz J . [Alveolar hemorrhagic syndrome in sarcoidosis]. Pneumologie. 1998; 52(1):21-3. View

20.

Clutterbuck E, Pusey C . Severe alveolar haemorrhage in Churg-Strauss syndrome. Eur J Respir Dis. 1987; 71(3):158-63. View