The Drug-Induced Respiratory Disease Website

Anticoagulants, oral (vitamin K antagonists-VKA)

Thoracic epidural or spinal hematoma

May cause spinal compression

Ordookhanian C, Kaloostian SW, Kaloostian PE

Anti-coagulation Drug Warfarin Contributes to Severe Adverse Outcomes in Prolonged Unsupervised Use: A Double-edged Sword.

Cureus 2018 Sep 22;10;e3347 — 2018 Sep 22 — e3347

Inamasu J, Ito K, Hattori N, Hirose Y

Warfarin-associated Intraspinal Hematoma.

The Keio journal of medicine 2016 Dec 25;65;74-77 — 2016 Dec 25 — 74-77

Basamh M, Robert A, Lamoureux J, Saluja RS, Marcoux J

Epidural Hematoma Treated Conservatively: When to Expect the Worst.

The Canadian journal of neurological sciences. Le journal canadien des sciences neurologiques 2016 Jan;43;74-81 — 2016 Jan — 74-81

Diagnosing DIRD

Drug and radiation history

Drug singularity - Correct identification of the drug

Consistent timing of exposure v. onset of symptoms

Clinical, imaging, BAL, pathological pattern consistent with the specific drug

Careful exlusion of another cause

Remission of symptoms with removal of drug

Recurrence with rechallenge (rarely advisable)

Causality assessment

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