54 Days Without Anticoagulation in a Patient with Metallic Mitral Valve

Abstract

In patients with a mechanical heart valve, adequate anticoagulation is extremely important, as coagulation poses a risk of embolism and thrombosis of the valve. However, in patients with a metallic heart valve suffering an intracranial bleed, there is a high mortality rate. This can become a management dilemma, as limited evidence is available to guide clinical decision-making in this situation. Each case must be assessed individually, ideally with a multidisciplinary team approach. Here, we report the case of a woman in her 80s presenting with acute massive subdural hemorrhage because of a fall. We examine the complex repercussions of specific decisions in a very critical clinical scenario. Furthermore, we suggest that a revision of anticoagulation guidelines may be necessary.