Clinical Insight on Warfarin Induced Diffuse Alveolar Haemorrhage: A Case Report
G. Harine *
C. L. Baid Metha College of Pharmacy, the Tamil Nadu Dr. MGR Medical University, Chennai, Tamil Nadu, India.
S. Jeevitha
C. L. Baid Metha College of Pharmacy, the Tamil Nadu Dr. MGR Medical University, Chennai, Tamil Nadu, India.
S. Suresh
Department of Pulmonary and Critical Care Medicine, Gleneagles Global Health City, Chennai, India.
*Author to whom correspondence should be addressed.
Abstract
Background: Diffuse alveolar haemorrhage (DAH) is a serious condition which requires a medical emergency. A contributing factor to DAH is anticoagulant treatment. Warfarin has been used as prophylaxis and treatment of venous thrombosis, thromboembolic complications from atrial fibrillation or cardiac valve replacement. Warfarin-induced diffuse alveolar haemorrhage is a serious medical condition. Initially, the diagnosis of DAH and for other pulmonary conditions clinical presentation and chest X-ray were enough to suggest the diagnosis.
Case Report: In this report a 72-year-old female patient with a history of Coronary Artery Disease (CAD), Hypertension, and surgical procedure of Aortic Valve Replacement (AVR) and Percutaneous Transluminal Coronary Angioplasty (PTCA). She was on warfarin therapy for 5 years and was admitted to the hospital for severe cough, haemoptysis and dyspnoea. DAH was suspected clinically and confirmed by Computed Tomography (CT) chest and bronchoscopy. The patient required treatment with non-invasive ventilation and fresh frozen plasma and other supportive care. Early diagnosis and treatment are highlighted in our case and an anticoagulation reversal is required. Therefore, it is important to carefully monitor patients receiving warfarin therapy for the main symptoms of such an incident and to start treatment as soon as possible in order to reduce mortality.
Keywords: Diffuse alveolar haemorrhage, warfarin, anticoagulants, bronchoscopy, PT-INR