Retropharyngeal and bowel hematomas in an anticoagulated patient.

As the indications for oral anticoagulation therapy increase, the number of patients being treated with anticoagulants and at risk for complications also will rise. Major bleeding episodes have been reported to occur in approximately 2-4% of patients being treated with oral anticoagulants. The case report of a patient with concurrent spontaneous retropharyngeal and small-bowel hematomas from overanticoagulation with warfarin is presented. The authors review the subtle presentation of retropharyngeal hematomas, common medications that may enhance warfarin anticoagulation, and therapy of potentially life-threatening hematomas. Airway management and possible surgical therapies to treat the complications of hematomas are discussed. Depending upon the indication for the initial anticoagulation, interim anticoagulation with heparin may be indicated.