warfarin and Hematoma--Subdural--Acute

Topics: Adult; Anticoagulants; Antiphospholipid Syndrome; Aortic Valve; Aortic Valve Stenosis; Benzoates; Bicuspid Aortic Valve Disease; Bioprosthesis; Chest Pain; Craniotomy; Echocardiography; Echocardiography, Three-Dimensional; Echocardiography, Transesophageal; Enoxaparin; Female; Heart Valve Diseases; Heart Valve Prosthesis; Heart Valve Prosthesis Implantation; Hematoma, Subdural, Acute; Humans; Hydrazines; Immunologic Factors; Plasma Exchange; Purpura, Thrombocytopenic, Idiopathic; Pyrazoles; Recurrence; Rituximab; Stroke Volume; Thrombosis; Ventricular Dysfunction, Left; Warfarin

Topics: Aged; Anticoagulants; Hematoma, Subdural, Acute; Humans; Male; Myelodysplastic Syndromes; Pancytopenia; Remission, Spontaneous; Warfarin

We report the first case of acute subdural hematoma (SDH) developing after tightening the halo of an osteoporotic 61-year-old woman on warfarin therapy for bilateral traumatic vertebral artery dissection. We discuss literature relevant to this case with an emphasis on identifying warning signs, including recurrent pin loosening, especially in patients with compromised bone structure and high risk of bleeding. Our 61-year-old patient presented to neurosurgery clinic for a 2-month follow-up of a type-III odontoid fracture sustained in a motor vehicle accident. The patient had repeatedly loosened halo pins, and shortly after the pins were tightened, the patient had a syncopal event and struck her head. An emergent computed tomography scan revealed acute SDH requiring emergent craniotomy and evacuation. SDH following pin penetration in a patient with bilateral vertebral artery dissection, osteoporosis, and anticoagulation has not been reported as a complication of the use of the halo vest for stabilization of the cervical spine. The risk of this serious complication can be minimized by giving special consideration to patients with comorbidities and by repositioning problematic pins. This case demonstrates the importance of special attention to bone strength, bleeding risk, and recurrent minor complaints with use of the halo vest.

Topics: Accidental Falls; Accidents, Traffic; Anticoagulants; Bone Nails; Craniocerebral Trauma; Craniotomy; Device Removal; Equipment Failure; Female; Hematoma, Subdural, Acute; Hemorrhagic Disorders; Humans; Immobilization; Middle Aged; Odontoid Process; Osteoporosis, Postmenopausal; Risk Factors; Spinal Fractures; Syncope; Tomography, X-Ray Computed; Vertebral Artery Dissection; Warfarin

Recombinant activated factor VII (rFVIIa) (NovoSeven; Novo Nordisk A/S, Bagsvaerd, Denmark) is a haemostatic agent first developed for bleeding associated with haemophilia and trauma, but for which the indications continue to expand. Recent reports have suggested efficacy for various types of intracranial haemorrhage and for patients with abnormalities of coagulation. We report a warfarin-anticoagulated Jehovah's Witness patient with an acute subdural haematoma for whom rFVIIa was used perioperatively. The haematoma was surgically evacuated without excessive blood loss and the patient eventually made a good recovery, returning to independent self-care.

Topics: Aged; Anticoagulants; Atrial Fibrillation; Coagulants; Factor VII; Female; Hematoma, Subdural, Acute; Humans; Jehovah's Witnesses; Recombinant Proteins; Treatment Outcome; Warfarin

Topics: Adult; Anticoagulants; Female; Hematoma, Subdural, Acute; Humans; Tomography, X-Ray Computed; Treatment Outcome; Warfarin

In this report the authors describe the use of the hemostatic agent recombinant activated factor VII (rFVIIa) in the perioperative treatment of hemorrhages in the central nervous system that are associated with warfarin therapy.. Two patients sustained hemorrhages within the spinal canal, and the other two had acute intracranial subdural hematomas. All patients had normal platelet counts, activated partial thromboplastin times, and fibrinogen levels, and all received fresh frozen plasma in conjunction with rFVIIa. The initial international normalized ratios (INRs) ranged from 1.9 to 5.6. Each dose of rFVIIa was 1200 microg, ranging from 16 to 22 microg/kg of body weight. Two patients received two perioperative doses of rFVIIa; the others required just one dose before surgery. The INR normalized within 2 hours of administration of rFVIIa in all patients. There were no thromboembolic complications, and surgical blood loss was less than 100 ml for all operations.. This clinical experience indicates that rFVIIa may be safe and effective as the initial hemostatic agent for rapid reversal of orally administered anticoagulation medications in patients who require urgent neurosurgical intervention.

Topics: Acute Disease; Aged; Anticoagulants; Craniotomy; Factor VII; Factor VIIa; Female; Heart Valve Prosthesis; Hematoma, Subdural; Hematoma, Subdural, Acute; Hemostasis, Surgical; Humans; Male; Middle Aged; Preoperative Care; Recombinant Proteins; Treatment Outcome; Warfarin

Intracranial hemorrhage, either spontaneous or traumatic is a well-known and potentially lethal complication of Warfarin treatment. Patients with Warfarin-related intracranial hemorrhage need urgent reversal of anticoagulation that must be especially rapid if surgical intervention is indicated. The traditional treatment with fresh frozen plasma (FFP) and vitamin K often fails to achieve the desired correction of coagulopathy in urgent neurosurgical settings.. In the present case Recombinant Coagulation Factor VIIa (rFVIIa) was used for preoperative reversal of Warfarin-related coagulopathy. The patient was a fifty two years old man, mechanic valve recipient with Warfarin-induced coagulopathy: International Normalization Ratio (INR) of 6.39, who suffered from acute subdural hematoma and needed urgent neurosurgical intervention. He received a single dose of rFVIIa 120 mg/kg and immediately underwent craniotomy and evacuation of the hematoma. Appropriate hemostasis was achieved during surgery and coagulation test taken two hours after rFVIIa injection revealed INR of 1.25. The INR remained normalized for additional 14 hours. To the best of our knowledge, this is the first report on the use of rFVIIa in the preoperative management of Warfarin-induced intracranial hemorrhage.. Recombinant Coagulation Factor VIIa provides rapid correction of coagulation to a level that allows safe neurosurgical intervention without significant delay. This agent is safe and effective; and should be considered for reversal of Warfarin-induced coagulopathy in cases of intracranial hemorrhage, especially when urgent surgical intervention is required.

Topics: Craniotomy; Factor VIIa; Heart Valve Prosthesis; Hematoma, Subdural, Acute; Hemostasis, Surgical; Humans; Male; Middle Aged; Preoperative Care; Recombinant Proteins; Warfarin