Een cardiocerebraal stollingsdilemma bij een oudere patiënte

Abstract

A cardio-cerebral coagulation dilemma A 77-year-old patient with permanent atrial fibrillation and mechanical heart valves on a treatment with fenprocoumon developed a subdural hematoma after an in-hospital fall. The initially successful burr-hole trepanation was followed by an expanding contralateral subdural hematoma with midline shift 36 hours later. Because of the prior cognitive and functional decline with recurrent falls and an irreconcilable dilemma between the need for thrombo-embolic prevention with adequate anticoagulation and the need for neuroprotection with normal clotting times, the prognosis was considered to be poor. A multidisciplinary decision was made offering the best supportive care without further neurosurgical treatment.