The dilemma of anticoagulating patients with cerebral venous thrombosis who underwent decompressive craniectomy.

World Neurosurg. 2018 Mar 21. pii: S1878-8750(18)30585-0. doi: 10.1016/j.wneu.2018.03.103. [Epub ahead of print]

The dilemma of anticoagulating patients with cerebral venous thrombosis who underwent decompressive craniectomy.

Abstract

BACKGROUND:

Cerebral venous thrombosis (CVT) is an uncommon subtype of cerebrovascular accident. The time to be allowed between decompressive craniectomy (DC) and the onset of anticoagulation in patients diagnosed with CVT is still a controversial topic among neurosurgeons, neurologists, and intensivists.

CASE DESCRIPTION:

We present a brief clinical case report of a female patient who underwent DC and was later diagnosed with CVT, for whom anticoagulation was initiated 24 hours postoperatively.

CONCLUSIONS:

We highlight the importance of early onset of anticoagulation for a favorable outcome. In view of that, we propose that clinical decision-making should rely on the following premises: (1) postoperative imaging studies with no evidence of increase in the hematoma, (2) intracranial pressure monitoring for patients on mechanical ventilation, and (3) protocols for immediate suspension of anticoagulants and use of antagonistic drugs in case of an increase in a pre-existing intracranial hemorrhage.

KEYWORDS:

anticoagulation; cerebral venous sinus thrombosis; decompressive craniectomy

PMID:

 

29574222

 

DOI:

 

10.1016/j.wneu.2018.03.103

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