The Dilemma of Anticoagulating Patients with Cerebral Venous Thrombosis Who Underwent Decompressive Craniectomy

Cerebral venous thrombosis is an uncommon subtype of cerebrovascular accident. The appropriate time interval between decompressive craniectomy and the onset of anticoagulation in patients with cerebral venous thrombosis is a controversial topic among neurosurgeons, neurologists, and intensivists. We...

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Bibliographic Details
Published in:	World neurosurgery Vol. 114; pp. 168 - 171
Main Authors:	Mendes, Plinio Duarte, Lopes, Clayton Lucas da Silva, França, Diogo Mendes, Reis, Jarbas Carvalhais, Santos, Augusto Cesar de Jesus, Darwich, Rogerio Zenobio
Format:	Journal Article
Language:	English
Published:	United States Elsevier Inc 01-06-2018
Subjects:	Adult Anticoagulants - administration & dosage Anticoagulation Cerebral venous sinus thrombosis Decompressive craniectomy Decompressive Craniectomy - adverse effects Decompressive Craniectomy - methods Drug Administration Schedule Female Humans Intracranial Thrombosis - diagnostic imaging Intracranial Thrombosis - drug therapy Intracranial Thrombosis - etiology Intraoperative Complications - diagnostic imaging Intraoperative Complications - drug therapy Intraoperative Complications - etiology Venous Thrombosis - diagnostic imaging Venous Thrombosis - drug therapy Venous Thrombosis - etiology CVT Cerebral venous sinus thrombosis CT Anticoagulation Decompressive craniectomy DC
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Summary:	Cerebral venous thrombosis is an uncommon subtype of cerebrovascular accident. The appropriate time interval between decompressive craniectomy and the onset of anticoagulation in patients with cerebral venous thrombosis is a controversial topic among neurosurgeons, neurologists, and intensivists. We present a brief clinical case report of a female patient who underwent decompressive craniectomy. Cerebral venous thrombosis was subsequently diagnosed, and anticoagulation was initiated 24 hours postoperatively. Early onset of anticoagulation is important for a favorable outcome. Clinical decision making should rely on the following: 1) postoperative imaging studies with no evidence of increase in 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. •The case of a patient with cerebral venous thrombosis who underwent decompressive craniectomy is presented.•The time between surgery and onset of anticoagulation is discussed with aspects to be considered in clinical decision making.•Cases should be treated on an individual basis and evaluated based on imaging and venous congestion on cerebral angiography.•Early re-establishment of venous blood flow is the most important factor for a favorable prognosis.
Bibliography:	ObjectType-Case Study-2 SourceType-Scholarly Journals-1 ObjectType-Feature-4 content type line 23 ObjectType-Report-1 ObjectType-Article-3
ISSN:	1878-8750 1878-8769
DOI:	10.1016/j.wneu.2018.03.103