Spontaneous spinal epidural hematoma in a patient with a mechanical aortic valve taking warfarin.
A 59-year-old male with a mechanical aortic valve taking warfarin presented to hospital with Brown-Séquard syndrome caused by a spontaneous spinal epidural hematoma (SSEH) precipitated by a coughing fit. Guided by a literature review of the risks of administering or withholding anticoagulation in this patient, doctors advised a regimen of warfarin to achieve an international normalized ratio of 1.5 to 2 and dipyridamole (75 mg qid) to protect against thromboembolic complications while minimizing the risk of recurrent SSEH.
Maingi
M
M
Department of Medicine, University of Toronto, Ontario.
Glynn
M F
MF
Scully
H E
HE
Graham
A F
AF
Floras
J S
JS
D000925:Anticoagulants / Q000008:administration & dosage / Q000009:adverse effects; D001021:Aortic Valve; D004305:Dose-Response Relationship, Drug; D004617:Embolism / Q000517:prevention & control; D004824:Epidural Space / Q000098:blood supply*; D015444:Exercise; D006350:Heart Valve Prosthesis; D006407:Hematoma, Epidural, Cranial / Q000139:chemically induced*; D006801:Humans; D008297:Male; D008875:Middle Aged; D012307:Risk Factors; D013122:Spinal Diseases / Q000139:chemically induced*; D013927:Thrombosis / Q000517:prevention & control; D014859:Warfarin / Q000008:administration & dosage / Q000009:adverse effects*
D000925:Anticoagulants; D014859:Warfarin