Obstructive Pharyngo-Laryngeal Hematoma Complicating Oral Anticoagulation: Case Report

Document Type : Case Report

Authors

Department of Otorhinoloaryngology Head and Neck Surgery, La Rabta Hospital, Tunisia.

10.22038/ijorl.2025.82416.3772

Abstract

Introduction:
Spontaneous pharyngo-laryngeal hematoma in patients receiving oral anticoagulants is rare and potentially fatal because of upper airway obstruction. Many risk factors can cause potential hemorrhagic complications, such as drug interactions.
Case Report:
We present the case of a 74-year-old man who was on oral anticoagulation by acenocoumarol and presented with acute laryngeal dyspnea. The final diagnosis of pharyngo-laryngeal hematoma secondary to hypercoagulation was made based on the clinical, biological, and radiological features.
Therefore, conservative management was initiated. Drug interactions between anticoagulants and macrolides were the probable underlying causes of excessive anticoagulation.
Conclusion:
Pharyngo-laryngeal hematoma should be considered in patients receiving anticoagulant therapy with symptoms of upper airway obstruction. Drug interactions may be the underlying cause of hypercoagulation, so medications should be carefully prescribed to these patients.  

Keywords

Main Subjects


  1. Chin KW, Sercarz JA, Wang MB, Andrews R. Spontaneous cervical hemorrhage with near-complete airway obstruction. Head Neck. 1998;20(4):350–3.
  2. Kerr HD, Kwaselow A. Vocal cord hematomas complicating anticoagulant therapy. Ann Emerg Med. 1984;13(7):552–3.
  3. Divya GM, Dahiya V, Ramachandran K, Muhammed F. Drug-induced airway hematoma. Int J Otolaryngol Head Neck Surg. 2015;6(4):187–9.
  4. Bloom DC, Haegen T, Keefe M. Anticoagulation and spontaneous retropharyngeal hematoma. J Emerg Med. 2002;24(4):389–94.
  5. Kabagenyi F, Hidour R. Spontaneous retropharyngeal haematoma causing upper airway obstruction in a child: case report. Int Med Case Rep J. 2022;15:739–43.
  6. Ashraf A, Bannon M, Smith C, Kaushik P, Marak C. Upper airway hematoma! An unusual presentation of acute upper airway obstruction. Respir Med Case Rep. 2022; Available from: http://doi.org/10.1016/j.rmcr.2022.101612.
  7. Triaridis S, Tsiropoulos G, Rachovitsas D, Psillas G, Vital V. Spontaneous haematoma of the pharynx due to a rare drug interaction. Hippokratia. 2009;13(3):175–7.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

  1. Thomas SA, Moideen SP, George SM, Ipe S, Menon DG. Management of spontaneous neck hematoma in patients on anticoagulant therapy: our experience from a tertiary care center. Indian J Otolaryngol Head Neck Surg. 2022;75(3). Available from: http://doi.org/10.1007/s12070-021-02990-2.
  2. Olandsobo AG, Lazraq M, Bensaid A, Miloudi Y, El Harrar N. Hématome cervical spontané et du plancher buccal : localisation inhabituelle d’un accident hémorragique aux antivitamines K. À propos d’un cas. Anesth Reanim. 2018. Available from: https://doi.org/10.1016/j.anrea.2018.01.001.
  3. Grau E. Interaction between clarithromycin and anticoagulants. Ann Pharmacother. 1996; 30(12): 1495.