Postoperative anticoagulation in patients with mechanical heart valves following surgical treatment of subdural hematomas

Anubhav G. Amin, Julie Ng, Wesley Hsu, Gustavo Pradilla, Shaan Raza, Alfredo Quinones-Hinojosa, Michael Lim

Research output: Contribution to journalArticle

8 Scopus citations

Abstract

Background: Thromboembolic events and anticoagulation-associated bleeding events represent frequent complications following cardiac mechanical valve replacement. Management guidelines regarding the timing for resuming anticoagulation therapy following a surgically treated subdural hematoma (SDH) in patients with mechanical valves remains to be determined. Objective: To determine optimal anticoagulation management in patients with mechanical heart valves following treatment of SDH. Methods: Outcomes were retrospectively reviewed for 12 patients on anticoagulation therapy for thromboembolic prophylaxis for mechanical cardiac valves who underwent surgical intervention for a SDH at the Johns Hopkins Hospital between 1995 and 2010. Results: The mean age at admission was 71 years. All patients had St. Jude's mechanical heart valves and were receiving anticoagulation therapy. All patients had their anticoagulation reversed with vitamin K and fresh frozen plasma and underwent surgical evacuation. Anticoagulation was withheld for a mean of 14 days upon admission and a mean of 9 days postoperatively. The average length of stay was 19 days. No deaths or thromboembolic events occurred during the hospitalization. Average follow-up time was 50 months, during which two patients had a recurrent SDH. No other associated morbidities occurred during follow-up. Conclusion: Interruptions in anticoagulation therapy for up to 3 weeks pose minimal thromboembolic risk in patients with mechanical heart valves. Close follow-up after discharge is highly recommended, as recurrent hemorrhages can occur several weeks after the resumption of anticoagulation.

Original languageEnglish (US)
Pages (from-to)90-94
Number of pages5
JournalNeurocritical care
Volume19
Issue number1
DOIs
StatePublished - Aug 1 2013

Keywords

  • Anticoagulation
  • Hemorrhage
  • Mechanical heart valve
  • Subdural hematoma
  • Thromboembolism

ASJC Scopus subject areas

  • Clinical Neurology
  • Critical Care and Intensive Care Medicine

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