Emergent management of a case with acute sub-dural hematoma post mechanical mitral valve replacement on warfarin therapy

Abstract

The use of anticoagulants to prevent thromboembolic complications post mechanical valve replacement is associated with intracranial or subdural hemorrhage.  In such cases, the scale has to be balanced to have a good anticoagulation in order to prevent thromboembolism and to have a target INR (International normalized ration) in order to avoid hemorrhages specifically intracranial hemorrhages. A controversy exists on reversal of anticoagulation for emergency surgery and management may differ from case to case. Here, we report a case with massive subdural hematoma on warfarin post mechanical mitral valve replacement for emergency craniotomy and evacuation. Effective optimization and correction of INR by reversing anticoagulation lead to an improved outcome without further increase in thromboembolic complications.