Case Study: HA Case With Sponatenous Bleeing
HA Case With Sponatenous Bleeding From Ear Due To Warfarin Overdose
Introduction: Warfarin has anticoagulant activity with inhibiting vitamin-K dependent coagulation factors. It has a narrow therapeutic range and it is difficult to maintain the therapeutic range. Therefore, over-anticoagulation is common. In this case report, a spontaneous isolated otorrhagia secondary to warfarin use, is presented.
Case: A 30-year-old female patient was visited to the emergency clinic with a sudden onset of hearing loss at home and a complaint of bleeding from ear. There was mitral valve replacement and warfarin use in the history. The auricula, periauricular region and mastoid region were normal in the ear examination of the patient. Her right tympanic …show more content…
No abnormal signals were detected in the brain parenchyma, but there was an increased density in the right external auditory canal, in the computerized brain tomography, (Figure 1). The patient was given 5 mg K vitamin intravenously and 10 ml/kg fresh frozen plasma. The patient was consulted the otorhinolaryngology department, immediate surgical intervention was not considered. The patient's aPTT was 41 sec, PT was 24.7 sec, INR was 2.06 at the 8th hour after the medical treatment. The patient was discharged with recommendations from emergency clinic, after the bledding from ear stopped and the aural fullness decreased.
Figure 1- Increased density in the right external auditory canal
Conclusion: The most important side effect of anticoagulation is hemorrhage. Although it is most commonly seen as ecchymosis; hematuria, upper gastrointestinal hemorrhage, gingival hemorrhage are other common bleeding patterns. Intracerebral hemorrhage, which may be fatal but often uncommon, may occur in warfarin-induced hemorrhage. The patients awareness should be provided about side effects and potential risks, because of narrow therapeutic range and life-threatening complications. It should also be recommended not to neglect the INR
Introduction: Warfarin has anticoagulant activity with inhibiting vitamin-K dependent coagulation factors. It has a narrow therapeutic range and it is difficult to maintain the therapeutic range. Therefore, over-anticoagulation is common. In this case report, a spontaneous isolated otorrhagia secondary to warfarin use, is presented.
Case: A 30-year-old female patient was visited to the emergency clinic with a sudden onset of hearing loss at home and a complaint of bleeding from ear. There was mitral valve replacement and warfarin use in the history. The auricula, periauricular region and mastoid region were normal in the ear examination of the patient. Her right tympanic …show more content…
No abnormal signals were detected in the brain parenchyma, but there was an increased density in the right external auditory canal, in the computerized brain tomography, (Figure 1). The patient was given 5 mg K vitamin intravenously and 10 ml/kg fresh frozen plasma. The patient was consulted the otorhinolaryngology department, immediate surgical intervention was not considered. The patient's aPTT was 41 sec, PT was 24.7 sec, INR was 2.06 at the 8th hour after the medical treatment. The patient was discharged with recommendations from emergency clinic, after the bledding from ear stopped and the aural fullness decreased.
Figure 1- Increased density in the right external auditory canal
Conclusion: The most important side effect of anticoagulation is hemorrhage. Although it is most commonly seen as ecchymosis; hematuria, upper gastrointestinal hemorrhage, gingival hemorrhage are other common bleeding patterns. Intracerebral hemorrhage, which may be fatal but often uncommon, may occur in warfarin-induced hemorrhage. The patients awareness should be provided about side effects and potential risks, because of narrow therapeutic range and life-threatening complications. It should also be recommended not to neglect the INR