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| CASE SERIES |
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| Year : 2014 | Volume
: 60
| Issue : 2 | Page : 194-197 |
The dangerous gamble of heparinization within two weeks of nonoperative traumatic acute subdural hematoma in patients with increased stroke risk: A case series
S McClelland1, SJ Mackey2, SS Kim1
1 Department of Neurosurgery, Lahey Clinic, Burlington, Massachusetts, United States
2 Department of General Surgery, Lahey Clinic, Burlington, Massachusetts, United States
Correspondence Address:
3rd S McClelland
Department of Neurosurgery, Lahey Clinic, Burlington, Massachusetts
United States
 Source of Support: None, Conflict of Interest: None  | Check |
DOI: 10.4103/0022-3859.132344
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.
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