Tracheal Calcification Following Warfarin Administration: A Case Report
Abstract
Warfarin ought to be utilized for an extended duration in individuals with a predisposition to thromboembolism, such as those with atrial fibrillation or aortic valve replacement. While the primary complication of long-term warfarin usage is the potential for bleeding, there are also infrequent complications like vascular and tracheal calcification. We present a case of a patient who experienced diffuse tracheal calcification as a result of long-term warfarin usage.
A 74-year-old female patient, who had been receiving chronic warfarin treatment for atrial fibrillation, required intubation and was admitted to the intensive care unit due to aspiration pneumonia. As the patient was unable to be extubated during the hospital stay, she became a candidate for Percutaneous dilution tracheostomy (PDT). It was discovered during the PDT procedure that all available spaces of the trachea above the sternum were calcified, preventing the passage of the trach needle. The presence of tracheal calcification was confirmed by both a radiologist and ultrasound examination.
Currently, individuals are compelled to employ oral anticoagulants, like warfarin, in order to avert thromboembolic diseases. Nevertheless, the protracted utilization of warfarin is linked with infrequent adverse outcomes, such as disseminated calcification. Consequently, meticulous scrutiny of these side effects is requisite for patients with enduring warfarin consumption.
[2] Shen G, Yin H, Cao Y, Zhang M, Wu J, Jiang X, et al. Percutaneous dilatational tracheostomy versus fibre optic bronchoscopy-guided percutaneous dilatational tracheostomy in critically ill patients: a randomised controlled trial. Ir J Med Sci. 2019; 188(2):675-681.
[3] Alappan HR, Kaur G, Manzoor S, Navarrete J, O’Neill WC. Warfarin accelerates medial arterial calcification in humans. Arterioscler Thromb Vasc Biol. 2020; 40(5):1413-1419.
[4] Elango K, Javaid A, Khetarpal BK, Ramalingam S, Kolandaivel KP, Gunasekaran K, et al. The effects of warfarin and direct oral anticoagulants on systemic vascular calcification: a review. Cells. 2021; 10(4):773.
[5] Sasmita BR, Luo S, Huang B. Diffused calcification in a patient with long-term warfarin therapy: a case report. Eur Heart J Case Rep. 2022; 6(9):ytac364.
[6] Nie B, Zhang SY, Guan SM, Zhou SQ, Fang X. Role of Wnt/β-Catenin pathway in the arterial medial calcification and its effect on the opg/rankl system. Curr Med Sci. 2019; 39(1):28-36.
[7] Wang X, Peng L, Ma J, Zhang L, Liu J. Warfarin-Induced Calcification: Potential Prevention and Treatment Strategies. Reviews in Cardiovascular Medicine. 2022; 23(9):322.
[8] Epstein M. Matrix Gla-Protein (MGP) not only inhibits calcification in large arteries but also may be renoprotective: connecting the dots. EBioMedicine. 2016; 4:16-7.
[9] Siltari A, Vapaatalo H. Vascular calcification, vitamin K and warfarin therapy–possible or plausible connection?. Basic & Clinical Pharmacology & Toxicology. 2018; 122(1):19-24.
[10] Elango K, Javaid A, Khetarpal BK, Ramalingam S, Kolandaivel KP, Gunasekaran K, et al. The effects of warfarin and direct oral anticoagulants on systemic vascular calcification: a review. Cells. 2021; 10(4):773.
[11] Nour SA, Nour HA, Mehta J, Roy T, Byrd R. Tracheobronchial calcification due to warfarin therapy. Am J Respir Crit Care Med. 2014; 189(12):e73.
[12] Wei N, Lu L, Zhang H, Gao M, Ghosh S, Liu Z, et al. Warfarin accelerates aortic calcification by upregulating senescence-associated secretory phenotype maker expression. Oxid Med Cell Longev. 2020; 2020:2043762.
Files | ||
Issue | Vol 10 No 2 (2024): Spring | |
Section | Case Report(s) | |
DOI | https://doi.org/10.18502/aacc.v10i2.15069 | |
Keywords | ||
Warfarin Tracheobronchial calcification Anticoagulant Percutaneous dilution tracheostomy |
Rights and permissions | |
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License. |