Fatal pulmonary hemorrhage after taking anticoagulation medication

Our plain-English summary of Fatal pulmonary hemorrhage after taking anticoagulation medication, by S.P. Hammar (Respiratory Medicine Case Reports, 2015).

The study

• Author: S.P. Hammar
• Journal: Respiratory Medicine Case Reports
• Published: 2015;15:66-70
• Type of article: Case report
• Cited by: 2 articles, as counted by NIH iCite
• Read it: PubMed · Publisher · Free full text

Abstract

We describe a 64-year-old man with extensive diffuse acute lung hemorrhage, presumably as a result of anticoagulation therapy. We evaluated reports in the literature concerning acute exacerbation (acute lung injury of unknown cause) in UIP and other forms of fibrotic interstitial pneumonias. We also evaluated autopsy tissue in this case in order to determine the cause of death in this 64-year-old man, who was initially thought to have an asbestos-related disease. Based on the autopsy findings, this man died as a result of anticoagulation therapy; specifically, the use of Xarelto(®) (rivaroxaban).

In plain English

This case report described a 64-year-old man with a history of asbestos exposure. There was concern that he might have an asbestos-related disease. After a right knee replacement in December 2013, he was prescribed a 21-day supply of the anticoagulant (blood thinner) rivaroxaban (Xarelto), 10 mg daily. About two weeks after he stopped taking it, he was admitted to hospital in January 2014 with a violent cough and extreme shortness of breath. A lung biopsy showed changes consistent with usual interstitial pneumonia (UIP). He began coughing up bloody mucus and was restarted on rivaroxaban at 20 mg daily. Asbestosis was listed as a clinical diagnosis, but the article states he did not have radiographic or pathologic asbestosis. He died on February 15, 2014. At autopsy both lungs were extensively hemorrhagic, with alveolar spaces filled with fresh blood. No hyaline pleural plaques and no tumor were found. The author also reviewed published reports on acute lung injury and on bleeding with anticoagulants. The author concluded that the lung hemorrhage resulted from anticoagulation therapy, not an acute exacerbation of idiopathic pulmonary fibrosis.

We wrote this plain-English summary from the full article with the help of AI, and a second AI model checked each sentence against the article. It is not the authors' wording; the abstract and the article are their own account.

What the study did and found

• Design: Single case report with autopsy, plus a review of published literature on acute exacerbation of fibrotic lung disease and on bleeding with anticoagulants
• Who was studied: One 64-year-old Caucasian man in the USA who had a right total knee replacement on December 4, 2013 and died on February 15, 2014
• Exposure: The anticoagulant rivaroxaban (Xarelto): 10 mg by mouth daily (a 21-day supply) after knee surgery, later restarted at 20 mg daily. Enoxaparin (heparin) was also given in hospital. The patient also had a prior history of asbestos exposure (fiber type not stated).
• Main results:
  • Lung biopsy in January 2014 showed patchy interstitial fibrosis consistent with usual interstitial pneumonia (UIP), with focal organizing pneumonia
  • The patient started coughing up bloody mucus on 1/23/14 and was restarted on 20 mg of Xarelto from 1/26/14
  • Asbestosis was a clinical discharge diagnosis only; the patient did not have radiographic or pathologic asbestosis
  • At autopsy, no hyaline pleural plaques were found on the visceral or parietal pleura
  • Under the microscope, the lungs showed extensive hemorrhage with alveolar spaces filled with fresh blood, along with hyaline membranes and changes consistent with UIP
  • No tumor (neoplasm) was found in the lungs
• The authors' conclusion: The author concluded that there was no indication that the death was related to acute exacerbation of idiopathic pulmonary fibrosis. In the author's view, postmortem lung tissue showed extensive acute lung injury and hemorrhage resulting from anticoagulation therapy.

Topics

Medical terms in this study, explained in our Lexicon: Interstitial, Autopsy.

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