Abstract
Warfarin, a commonly used oral anticoagulant, is associated with several adverse drug reactions, principally bleeding. Of all hemorrhagic complications from warfarin therapy, thoracic hemorrhage accounts for only 3% and is usually related to trauma. Cases of spontaneous hemothorax secondary to anticoagulation therapy are rarely reported in the literature.
Highlights
A hemothorax is defined as a pleural effusion with a hematocrit of at least 50% that of the peripheral blood
Important risk factors for major hemorrhage due to warfarin therapy include a history of gastrointestinal bleeding, concurrent use of antiplatelet or nonsteroidal antiinflammatory drugs, genetic differences in warfarin metabolism, international normalized ratio (INR) variability, comorbidities, and duration of oral anticoagulant therapy [2,3]
Hemothorax is a major indication for tube thoracostomy, in cases with a mediastinal shift
Summary
A hemothorax is defined as a pleural effusion with a hematocrit of at least 50% that of the peripheral blood. A 64-year-old male presented in the ambulatory setting for routine follow-up and monitoring labs for his chronic medical conditions At that time, his INR was found to be supratherapeutic at 13.31. On initial presentation to the emergency department, the patient was noted to be primarily asymptomatic and breathing comfortably His vital signs revealed tachycardia and hypotension with a recorded blood pressure of 91/46 mmHg. his vital signs revealed tachycardia and hypotension with a recorded blood pressure of 91/46 mmHg His past medical history included atrial fibrillation with warfarin used as anticoagulation, cerebrovascular accident, hypertension, diabetes mellitus, seizures, and end-stage renal disease on hemodialysis. Subsequent chest X-ray showed a persistent opacity over the left lung field (Figure 2); a repeat CT scan revealed a large loculated hemothorax (Figure 3). The tissue biopsy showed no features of granulomas, dysplasia, neoplastic lesions, or significant inflammation
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