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Postoperative Anticoagulation in Patients with Mechanical Heart Valves Following Surgical Treatment of Subdural Hematomas

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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.

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The authors received no financial support in conjunction with the generation of this submission.

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Authors and Affiliations

  1. Department of Neurosurgery, Johns Hopkins Medical Institutions, The Johns Hopkins University School of Medicine, Meyer Bldg. 8-161, 600 N. Wolfe St., Baltimore, MD, 21287, USA

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

  2. Wake Forest Baptist Medical Center, Medical Center Blvd, Winston Salem, NC, 27157, USA

    Wesley Hsu

Authors
  1. Anubhav G. Amin
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  2. Julie Ng
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  3. Wesley Hsu
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  4. Gustavo Pradilla
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  5. Shaan Raza
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  6. Alfredo Quinones-Hinojosa
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  7. Michael Lim
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Corresponding author

Correspondence to Anubhav G. Amin.

Additional information

Anubhav G. Amin and Julie Ng contributed equally to this study.

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Amin, A.G., Ng, J., Hsu, W. et al. Postoperative Anticoagulation in Patients with Mechanical Heart Valves Following Surgical Treatment of Subdural Hematomas. Neurocrit Care 19, 90–94 (2013). https://doi.org/10.1007/s12028-012-9704-2

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  • DOI: https://doi.org/10.1007/s12028-012-9704-2

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