naa a22 4500 510799248 CHVBK 20180411083347.0 cr unu---uuuuu 180411e20130801xx s 000 0 eng 10.1007/s12028-012-9704-2 doi (NATIONALLICENCE)springer-10.1007/s12028-012-9704-2 Postoperative Anticoagulation in Patients with Mechanical Heart Valves Following Surgical Treatment of Subdural Hematomas [Elektronische Daten] [Anubhav Amin, Julie Ng, Wesley Hsu, Gustavo Pradilla, Shaan Raza, Alfredo Quinones-Hinojosa, Michael Lim] Background: Thromboembolic events and anticoagulation-associated bleeding events represent frequent complications following cardiac mechanical valve replacement. Management guidelines regarding the timing for resuming anticoagulation therapy following a surgically treated subdural hematoma (SDH) in patients with mechanical valves remains to be determined. Objective: To determine optimal anticoagulation management in patients with mechanical heart valves following treatment of SDH. Methods: Outcomes were retrospectively reviewed for 12 patients on anticoagulation therapy for thromboembolic prophylaxis for mechanical cardiac valves who underwent surgical intervention for a SDH at the Johns Hopkins Hospital between 1995 and 2010. Results: The mean age at admission was 71years. All patients had St. Jude's mechanical heart valves and were receiving anticoagulation therapy. All patients had their anticoagulation reversed with vitamin K and fresh frozen plasma and underwent surgical evacuation. Anticoagulation was withheld for a mean of 14days upon admission and a mean of 9days postoperatively. The average length of stay was 19days. No deaths or thromboembolic events occurred during the hospitalization. Average follow-up time was 50months, during which two patients had a recurrent SDH. No other associated morbidities occurred during follow-up. Conclusion: Interruptions in anticoagulation therapy for up to 3weeks pose minimal thromboembolic risk in patients with mechanical heart valves. Close follow-up after discharge is highly recommended, as recurrent hemorrhages can occur several weeks after the resumption of anticoagulation. Springer Science+Business Media, LLC, 2012 Anticoagulation nationallicence Hemorrhage nationallicence Mechanical heart valve nationallicence Subdural hematoma nationallicence Thromboembolism nationallicence Amin Anubhav Department of Neurosurgery, Johns Hopkins Medical Institutions, The Johns Hopkins University School of Medicine, Meyer Bldg. 8-161, 600 N. Wolfe St., 21287, Baltimore, MD, USA aut Ng Julie Department of Neurosurgery, Johns Hopkins Medical Institutions, The Johns Hopkins University School of Medicine, Meyer Bldg. 8-161, 600 N. Wolfe St., 21287, Baltimore, MD, USA aut Hsu Wesley Wake Forest Baptist Medical Center, Medical Center Blvd, 27157, Winston Salem, NC, USA aut Pradilla Gustavo Department of Neurosurgery, Johns Hopkins Medical Institutions, The Johns Hopkins University School of Medicine, Meyer Bldg. 8-161, 600 N. Wolfe St., 21287, Baltimore, MD, USA aut Raza Shaan Department of Neurosurgery, Johns Hopkins Medical Institutions, The Johns Hopkins University School of Medicine, Meyer Bldg. 8-161, 600 N. Wolfe St., 21287, Baltimore, MD, USA aut Quinones-Hinojosa Alfredo Department of Neurosurgery, Johns Hopkins Medical Institutions, The Johns Hopkins University School of Medicine, Meyer Bldg. 8-161, 600 N. Wolfe St., 21287, Baltimore, MD, USA aut Lim Michael Department of Neurosurgery, Johns Hopkins Medical Institutions, The Johns Hopkins University School of Medicine, Meyer Bldg. 8-161, 600 N. Wolfe St., 21287, Baltimore, MD, USA aut Neurocritical Care Springer US; http://www.springer-ny.com 19/1(2013-08-01), 90-94 1541-6933 19:1<90 2013 19 12028 https://doi.org/10.1007/s12028-012-9704-2 text/html Onlinezugriff via DOI 1 research-article jats NATIONALLICENCE 856 40 https://doi.org/10.1007/s12028-012-9704-2 text/html Onlinezugriff via DOI NATIONALLICENCE 700 1- Amin Anubhav Department of Neurosurgery, Johns Hopkins Medical Institutions, The Johns Hopkins University School of Medicine, Meyer Bldg. 8-161, 600 N. Wolfe St., 21287, Baltimore, MD, USA aut NATIONALLICENCE 700 1- Ng Julie Department of Neurosurgery, Johns Hopkins Medical Institutions, The Johns Hopkins University School of Medicine, Meyer Bldg. 8-161, 600 N. Wolfe St., 21287, Baltimore, MD, USA aut NATIONALLICENCE 700 1- Hsu Wesley Wake Forest Baptist Medical Center, Medical Center Blvd, 27157, Winston Salem, NC, USA aut NATIONALLICENCE 700 1- Pradilla Gustavo Department of Neurosurgery, Johns Hopkins Medical Institutions, The Johns Hopkins University School of Medicine, Meyer Bldg. 8-161, 600 N. Wolfe St., 21287, Baltimore, MD, USA aut NATIONALLICENCE 700 1- Raza Shaan Department of Neurosurgery, Johns Hopkins Medical Institutions, The Johns Hopkins University School of Medicine, Meyer Bldg. 8-161, 600 N. Wolfe St., 21287, Baltimore, MD, USA aut NATIONALLICENCE 700 1- Quinones-Hinojosa Alfredo Department of Neurosurgery, Johns Hopkins Medical Institutions, The Johns Hopkins University School of Medicine, Meyer Bldg. 8-161, 600 N. Wolfe St., 21287, Baltimore, MD, USA aut NATIONALLICENCE 700 1- Lim Michael Department of Neurosurgery, Johns Hopkins Medical Institutions, The Johns Hopkins University School of Medicine, Meyer Bldg. 8-161, 600 N. Wolfe St., 21287, Baltimore, MD, USA aut NATIONALLICENCE 773 0- Neurocritical Care Springer US; http://www.springer-ny.com 19/1(2013-08-01), 90-94 1541-6933 19:1<90 2013 19 12028 Metadata rights reserved Springer special CC-BY-NC licence nationallicence BK010053 XK010053 XK010000 NATIONALLICENCE NATIONALLICENCE NL-springer