# A Case of Life-Threatening Abdominal Wall Hematoma Formation in a Patient on Warfarin Therapy with Concurrent Influenza Infection

## TL;DR

A patient on warfarin and infected with influenza developed a life-threatening abdominal wall hematoma, highlighting the risk of bleeding in anticoagulated patients with cough-related illnesses.

## Contribution

This case highlights the synergistic risk of warfarin therapy and influenza infection leading to severe hemorrhage.

## Key findings

- Warfarin therapy combined with influenza can lead to life-threatening abdominal wall hematomas.
- Coughing from influenza increases intra-abdominal pressure, exacerbating bleeding risks in anticoagulated patients.
- Early detection of hemorrhage in anticoagulated patients with respiratory infections improves outcomes.

## Abstract

Warfarin therapy provides extensive antithrombotic benefits and, thus, is widely used in the general population. However, as with most medications, there are also risks associated with warfarin use. Specifically, because of the narrow therapeutic window of this drug, patients taking it are at a much higher risk of accidental bleeding. Additionally, patients may also present with bleeding complications when infected with illnesses with coughing as a symptom, such as influenza or COVID-19. These patients have the potential to suffer hemorrhagic morbidities related to the increased intra-abdominal and intra-thoracic pressures that are generated from coughing. Moreover, a synergistic effect is seen when patients find themselves in a situation where they are taking anticoagulation therapy and become infected with illnesses such as influenza or COVID-19. We present a case in which an individual on warfarin therapy was infected with Influenza A. This combination of factors eventually led to massive hemorrhage and large abdominal wall hematoma formation. This case brings to light the importance of having a low threshold for considering the prospect of massive hemorrhage in any patient who is anticoagulated and develops a condition that is associated with increased abdominal pressure. Because these bleeding events can have devastating effects, raising awareness of this risk is increasingly important. Early detection of massive hemorrhage will lead to better outcomes and can ultimately be life-saving for these patients.