Spontaneous sublingual hematoma due to acenocoumarol therapy

Medical Review (Med. pregled), 2023, 59(4), 56-59.

S. Tepavski, L. Neykova-Vasileva

Department of Emergency Toxicology, Military Medical Academy – Sofia

Abstract. Spontaneous sublingual hematoma is a rare complication of oral anticoagulant therapy. Classical representatives of this class of medication are vitamin K antagonists. Their use in the medical practice has been established since 1950s. In Bulgaria acenocоumarol is the most popular drug of the type. We present a case of 60-year-old man with a history of regular acenocоumarol intake for peripheral vascular disease. The patient was referred to an emergency toxicologist because of occupational hazards and a suspected acute poisoning. In the initial assessment we observed odynophagia, edema and hematoma of sublingual space without signs of upper airways obstruction. The patient received specific antidotal therapy which resulted in correction of the present coagulopathy, resorption of the hematoma and reintroduction of anticoagulant therapy at optimal dosage regimen.

Key words: acenocоumarol, sublingual hematoma, phytomenadione, antidote

Address for correspondence: Lyudmila Neykova-Vasileva, MD, e-mail: lussi66@abv.bg