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The Drug-Induced Respiratory Disease Website and App

Anticoagulants, oral (vitamin K antagonists-VKA)

Therapeutic oral vitamin K antagonists (VKA) acenocoumarol, coumadin, coumarin, phenprocoumon, warfarin and the like. See also under the rodenticide/pesticides brodifacoum, diphacinone, diphenadione. See also under other anticoagulants heparin, thrombolytic agents, platelet glycoprotein aggregation inhibitors (anti-GPIIB/IIIA) (abciximab, ticlopidine, clopidogrel, eptifibatide) and direct (new) anti-IIa or anti-Xa oral anticoagulans (apixaban, dabigatran, rivaroxaban). Patients with pulmonary hypertension who receive oral anticoagulants are also at risk of hemorrhage in the chest and/or other organs. Drug abusers may surreptitiously take warfarin to prevent femoral vein thrombosis. Abused drugs and the smoke of certain cigarettes may contain coumarin or warfarin, causing coagulopathy (PMID 11547737, 17583404, 24275169). Antidotes and reversal agents: PMID 24275169, 26872887.

Frequency - Incidence

Incidence of respiratory adverse event(s) due to the specific drug as assessed by number of reported/published cases in the literature. Red digits in stars indicate: 0 = Very rare, questionable signal · 1 = < 10 cases · 2 = 10-50 cases · 3 = 50–100 cases · 4 = 100-200 cases · 5 = >200 cases

Evidence level/grade

Evidence level for respiratory adverse event(s) due to the specific drug as estimated using Hill’s (1965), Naranjo’s (1981), and Bégaud’s (1985) criteria applied to published cases. Blue digits in stars indicate: 0 = Questionable · 1 = Low · 2 = Moderate · 3 = Robust · 4 = Definite · 5 = Unquestionable, pathognomonic

I - Interstitial/parenchymal lung disease

I.y

Progression, acceleration or exacerbation of preexisting ILD/fibrosis

III - Pulmonary/alveolar/airway hemorrhage/bleeding

III.a

Alveolar hemorrhage (AH), diffuse AH (DAH)
III.c

Hemoptysis
III.e

Pulmonary hematoma
III.k

Epistaxis

IV - Airway involvement

IV.af

Calcification of tracheobronchial cartilaginous rings

V - Pleural and/or pericardial involvement

V.e

Hemothorax - Serosanguineous pleural effusion
V.n

Hemopericardium - Bloody pericardial effusion

VII - Mediastinal involvement

VII.g

Hemomediastinum - Mediastinal hematoma

VIII - Central-large-upper airway (incl. pharyngeal-nasal) involvement

VIII.a

Angioedema (may cause UAO, asphyxia and death)
VIII.b

Hematoma of/around central airway wall potentially causing UAO
VIII.q

Tongue involvement (edema, glossitis, hematoma)
VIII.u

Vocal cord hematoma
VIII.v

Retropharyngeal hematoma (may cause UAO)

IX - Neuromuscular / CNS involvement - Disordered breathing (during sleep)

IX.x

Thoracic epidural or spinal hematoma

X - Systemic/Distant conditions, syndromes and reactions

X.a

DRES syndrome - DRESS-like reaction

XI - Miscellaneous

XI.k

Esophageal hematoma (may cause chest pain and/or tracheal compression)
XI.am

Rectus abdominis hematoma

XII - Cardiovascular involvement / toxicity

XII.ar

Calcification of the coronary artery walls or atheroma

XIX - Cytological, biochemical features of/in BAL, pleural fluid or FNA

XIX.d

BAL: Gross or microscopic bleeding/hemorrhage
XIX.e

BAL: Stainable iron in macrophages

XXIV - Veterinary medicine

XXIV.e

Veterinary: Tracheal hemorrhage, stenosis, collapse