Abu Shammala Abdallah, Jaber Majed, Irfan Bilal, Owda Alaa, Herzallah Abdallah
Department of Internal Medicine, European Gaza Hospital, Khan Yunis, Gaza Strip, State of Palestine.
Department of Neurology, University of Michigan Medical School, Ann Arbor, Michigan, USA.
Case Rep Pulmonol. 2025 Aug 17;2025:8866411. doi: 10.1155/crpu/8866411. eCollection 2025.
Warfarin is widely prescribed for the prevention of thromboembolic events but carries a well-known risk of bleeding complications. While gastrointestinal and intracranial hemorrhages remain among the more frequent sites, pulmonary hemorrhage is an exceedingly rare case presentation and can be particularly catastrophic. We report the case of a 57-year-old male in Gaza with an extensive medical history of past hospitalization, who presented with severe ecchymosis, with his condition progressing to life-threatening pulmonary hemorrhage. This case occurred amid an active Israeli military assault in November 2024 in the European Gaza Hospital in Khan Yunis, at a time when diagnostic modalities had become limited or completely destroyed and healthcare resources were in severe shortage. The patient was treated with supportive measures, including mechanical ventilation and warfarin reversal using vitamin K and fresh frozen plasma. His anticoagulation regimen was changed to rivaroxaban. This case underlines the difficulties in diagnosing and managing rare but critical hemorrhagic complications in conflict-affected regions and emphasizes the urgency for clinicians to be vigilantly monitoring international normalized ratio values to conduct timely interventions.
华法林被广泛用于预防血栓栓塞事件，但存在众所周知的出血并发症风险。虽然胃肠道和颅内出血仍是较常见的出血部位，但肺出血是一种极其罕见的病例表现，且可能具有特别严重的后果。我们报告了一名来自加沙的57岁男性病例，他有多次住院的广泛病史，此次因出现严重瘀斑就诊，病情进展为危及生命的肺出血。该病例发生在2024年11月以色列在加沙地带汗尤尼斯的欧洲加沙医院发动的一次军事袭击期间，当时诊断手段受限或完全被毁，医疗资源严重短缺。患者接受了包括机械通气以及使用维生素K和新鲜冰冻血浆逆转华法林作用在内的支持性治疗措施。他的抗凝方案改为利伐沙班。该病例突显了在受冲突影响地区诊断和处理罕见但危急的出血并发症的困难，并强调临床医生迫切需要密切监测国际标准化比值以进行及时干预。
