Abstract
Background and purpose: Anticoagulation therapy increases the risk of chronic subdural hematoma (CSDH). In patients with mechanical heart valve prostheses, life-long oral anticoagulation therapy is recommended to prevent valve thrombosis and subsequent systemic embolism. The purpose of this study is to find out an appropriate perioperative management of CSDH in patients who are undergoing anticoagulation therapy after heart valve replacement.Methods: We retrospectively investigated the perioperative clinical course of five patients who underwent CSDH operation during anticoagulation therapy after heart valve replacement. Three of the five patients underwent mitral valve replacement and the other two patients underwent double (aortic and mitral) valve replacement. In all patients, warfarin was administered, while in three of these five patients, an antiplatelet was used together with warfarin. We evaluated the frequency of measurement of clotting time and CT imaging, timing of stopping anticoagulation therapy and removing drainage tube, presence of thromboembolic complications, and recurrence of the hematoma.Results: During the postoperative course, measurement of the clotting time and CT evaluation of the hematoma was performed 5.2 and 4.0 times per week, respectively, on the average. The subdural drainage tube was removed on postoperative day 1.8. Anticoagulation therapy was restarted with heparin and warfarin on postoperative day 1.2. Prior to surgery, warfarin was stopped in all patients and the reversal of anticoagulation with intravenous administration of vitamin K or fresh frozen plasma was achieved in two patients. All patients recovered without recurrence of the hematoma in the perioperative period.Conclusions: In the perioperative management of CSDH in patients undergoing anticoagulation therapy after valve replacement, repetitive CT evaluation and measurement of clotting time are suggested to be helpful to prevent the recurrence of CSDH and the possible thromboembolic complications.
