The retropharyngeal space is a rare site of spontaneous hemorrhage and the formation of a hematoma in this location is a rarer complication of therapy with anticoagulants. Nineteen cases of retropharyngeal hematoma have been reported in the literature, only two of which have been associated with anticoagulation therapy. In the case reported here, a retropharyngeal hematoma developed in a 61-year-old man who had been receiving anticoagulants. The complication was associated with a violent tussive episode. Airway obstruction necessitated a tracheostomy, and the persistent hematoma required external drainage.