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

Abstract

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.