Hemorrhagic complications due to
warfarin use are frequently seen in emergency departments. However, nontraumatic massive
hemothorax is an unexpected complication. We report a 59-year-old woman with
warfarin overdose, who had massive
hemothorax in right lung without any history of
trauma. Her main complaint was significant
dyspnea, which has gradually increased in three days. On her physical examination, she was tachypneic and had decreased
lung sounds on her right hemithorax. She took
warfarin regularly for aortic and mitral valve replacement for 18 years. Her INR level was 12.9 (0.8-1.2). Computed tomography of thorax revealed massive
hemothorax with mediastinal shift. Fresh frozen plasma infusion was started immediately. Tube
thoracostomy was performed for reexpansion of right lung and 2000 cc blood was drained in 5 minutes. Although hemorrhagic complications can be expected in
warfarin therapy, thoracic
hemorrhage related to
warfarin therapy is relatively rare (3% of all hemorrhagic complications due to
warfarin therapy). To our knowledge, massive
hemothorax due to
warfarin use is an extremely rare condition.