WHEN ANTICOAGULANTS LEAD TO A RESPIRATORY THREAT: A RARE ANTICOAGULANT-INDUCED SUBMANDIBULAR HEMATOMA CASE

Submandibular floor hematomas are rare but potentially life-threatening complications, often linked to anticoagulant therapy, coagulation disorders, trauma, or dental interventions. Spontaneous idiopathic hematomas, sometimes attributed to severe hypertension, have also been reported. We present the case of a 62-year-old woman with a history of mitral valve replacement and atrial fibrillation, treated with oral anticoagulants (Sintrom), who developed an idiopathic submandibular hematoma. The patient, who also had hypertension and diabetes, presented with a significant swelling in the floor of the mouth, causing elevation of the tongue, mild respiratory discomfort, dysphagia, and dysphonia. There was no clear trigger for the hematoma. Immediate management included oxygen therapy, antibiotics, and a comprehensive hemostatic workup, with consultation from cardiology and intensive care. Despite the severity of the hematoma, a tracheostomy was not required, in contrast to other cases reported in the literature where airway compromise necessitated more invasive interventions. This case underscores the importance of prompt recognition and multidisciplinary management of such rare complications, as well as the role of anticoagulant therapy in increasing the risk of severe hemorrhagic events.