Warfarin-associated intracranial haemorrhage in pregnant woman with double mechanical valve replacement: a case presentation.

Publisher: BioMed Central Country of Publication: England NLM ID: 100968539 Publication Model: Electronic Cited Medium: Internet ISSN: 1471-2261 (Electronic) Linking ISSN: 14712261 NLM ISO Abbreviation: BMC Cardiovasc Disord Subsets: MEDLINE

Original Publication: London : BioMed Central, [2001-

Heart Valve Prosthesis Implantation*/adverse effects; Anticoagulants/*adverse effects ; Aortic Valve/*surgery ; Intracranial Hemorrhages/*chemically induced ; Mitral Valve/*surgery ; Pregnancy Complications, Cardiovascular/*chemically induced ; Thrombosis/*prevention & control ; Warfarin/*adverse effects; Adult ; Female ; Humans ; Intracranial Hemorrhages/diagnostic imaging ; Intracranial Hemorrhages/surgery ; Live Birth ; Pregnancy ; Pregnancy Complications, Cardiovascular/diagnostic imaging ; Pregnancy Complications, Cardiovascular/surgery ; Thrombosis/etiology ; Treatment Outcome

Background: Management of warfarin-associated major haemorrhage in prosthetic valve diseases is difficult as there is a fine line between haemorrhage and thrombosis. An individual's propensity towards thrombosis, such as pregnancy, makes this situation even more complicated. Cases like these are very rare in the literature.
Case Presentation: A 26 weeks pregnant, gravida two, para one, 35-year-old patient with prosthetic aortic and mitral valves presented to an external emergency clinic with clouding of consciousness. Her international normalised ratio(INR) was 8.9 at presentation. Brain MRI revealed a left subdural haematoma with no significant mass effect. Warfarin treatment was discontinued. On the second day of follow-up, she was referred to our centre for further evaluation of her clinical deterioration. She was haemodynamically stable on admission to the intensive care unit and followed up with a stable condition until the fourth day when she developed right eye drop and subsequent loss of consciousness. Her haematoma was surgically evacuated, and her condition improved. Eventually, she and a healthy newborn were discharged.
Conclusion: Intracranial haemorrhage during pregnancy is a relatively rare complication that requires a multidisciplinary management plan. Although the thrombogenic risk is high, it is vital to complete a reversal of warfarin anticoagulation in pregnant women with major bleeding.

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Keywords: Case presentation; Intracranial haemorrhage; Major bleeding; Pregnant woman; Prosthetic valve replacement

0 (Anticoagulants)
5Q7ZVV76EI (Warfarin)

Date Created: 20200613 Date Completed: 20210111 Latest Revision: 20210111

20240829

PMC7291738

10.1186/s12872-020-01547-5

32527293