John,
Prosthetic aortic valve is not as vulnerable to the effects of short term
reversal of anticoagulation as mitral prosthesis (relaively high flow/valve
surface area).
Saying that, I would balence the risks versus benefits - clearly any hint of
on going bleeding/deterioration in level of conscious or in any patient
likley to require neurosurgery will require prompt reversal with FFP/low
dose vitamin K. Otherwise, assuming your patient was well and there was no
evidence of any subdural/extradural collection, I would admit & observe him
closely and await events.
John Black
-----Original Message-----
From: John Ryan [mailto:[log in to unmask]]
Sent: 12 October 2002 12:16
To: [log in to unmask]
Subject: Anticagulation and Head injuries
I am aware the list has discussed this topic recently but I would like to
add a new slant.
Views on how to manage a young man with a head injury and headache following
a fall from his bicycle.... CT shows temporal contusion. This chap is on
warfairn follwing his aortic valve replacement on a background of Marfan's
Syndrome.
The question is to reverse anticoagulation (INR 3.5) or not ?
Dr John Ryan
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