The dangerous gamble of heparinization within two weeks of nonoperative traumatic acute subdural hematoma in patients with increased stroke risk: A case series

S. McClelland, S. J. Mackey, S. S. Kim

Research output: Contribution to journalArticlepeer-review

2 Scopus citations

Abstract

Background: In traumatic acute subdural hematoma (aSDH) management, systemic anticoagulation is contraindicated, particularly during the first 2 weeks. We present two cases of patients with nonoperative aSDH whose stroke risk led to heparinization within 2 weeks of the initial hemorrhage and examine their outcomes to illustrate the risks and benefits associated with systemic anticoagulation. Materials and Methods: Two elderly males, on warfarin at baseline who developed traumatic nonoperative aSDH were heparinized within 2 weeks of aSDH onset. Results: One patient showed a decreased SDH volume on Day 19. The second patient developed sudden onset headache with fixed/dilated pupils on Day 5. In this patient, a CT scan of the brain revealed marked enlargement of the aSDH from 0.9 to 2.4 cm with midline shift of 1.5 cm, and uncal herniation that was incompatible with life. Conclusion: Heparinization within two weeks of aSDH may cause SDH enlargement resulting in rapidly fatal neurologic deterioration. Further study is needed to more definitively address this issue.

Original languageEnglish (US)
Pages (from-to)194-197
Number of pages4
JournalJournal of Postgraduate Medicine
Volume60
Issue number2
DOIs
StatePublished - 2014
Externally publishedYes

Keywords

  • Anticoagulation
  • conservative management
  • heparin
  • neurosurgery
  • stroke risk
  • traumatic acute subdural hematoma
  • warfarin

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