Reactions 1453 - 25 May 2013

SWarfarin

Diffuse alveolar haemorrhage: case reportA 56-year-old man experienced diffuse alveolar

haemorrhage (DAH) while receiving warfarin.The man was admitted to hospital with a 24-hour history of

aggravated dyspnoea. He had started receiving warfarin2–2.5mg [route and frequency not stated] 5 months earlier, fora pulmonary vein thrombosis. Initial investigations found thathis anticoagulation was suddenly prolonged; his activatedpartial thromboplastin time was 56 seconds and his INR was6.93. Chest x-ray showed increased bilateral pulmonaryinfiltrations and chest CT scan showed newly developedground-glass attenuations.

The man received empirical antibacterials and warfarin wasdiscontinued. Although his coagulation panel test resultsimproved after he received vitamin K and fresh frozen plasma,his oxygenation did not improve; he was intubated andmechanical ventilation was started. A diagnosis of DAH wasconfirmed when bronchoalveolar lavage became progressivelymore haemorrhagic. Extracorporeal membrane oxygenation(ECMO) was applied; 1 hour later his oxygenation hadimproved. Chest x-ray 5 days later showed improvement andECMO was removed. He was discharged from hospital45 days later, and remained free of respiratory symptoms.

Author comment: "The patient showed pure DAHconfined to the lungs. . . DAH is a rare complication ofwarfarin therapy. . . Our patient had abruptly increased INR,PT and aPTT."Lee JH, et al. Successful management of warfarin-exacerbated diffuse alveolarhemorrhage using an extracorporeal membrane oxygenation. MultidisciplinaryRespiratory Medicine 8: No. 2, 2013. Available from: URL: http://dx.doi.org/10.1186/2049-6958-8-16 - South Korea 803087053

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Reactions 25 May 2013 No. 14530114-9954/10/1453-0001/$14.95 Adis © 2010 Springer International Publishing AG. All rights reserved