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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