title: Successful management of an acute subdural hematoma in a patient dependent on continuous treprostinil infusion therapy.
abstract: Treprostinil is a synthetic analog of prostacyclin, which is used for treatment of pulmonary arterial hypertension (PAH). Continuous subcutaneous administration of treprostinil has been proven in randomized controlled trials to improve quality of life, hemodynamics, and 5-year survival in patients with PAH. The efficacy of treprostinil has been attributed to its vasodilatory and antiplatelet effects. Unfortunately, the efficacy of treprostinil in the treatment of PAH is rapidly reversed upon cessation of the continuous infusion. Furthermore, cases of patients rapidly declining or succumbing to disease progression upon cessation of treprostinil have raised significant concern regarding discontinuation of this medication. To date, there are no reports of emergency craniotomies performed in the setting of continuous subcutaneous infusion of treprostinil. The authors report a case of a patient with PAH, treated with continuous administration of subcutaneous treprostinil as well as warfarin, who developed an acute subdural hematoma (SDH). Despite adequate INR (international normalized ratio) correction, the patient eventually underwent an emergency craniotomy for evacuation of the SDH while on continuous treprostinil administration. This case highlights the neurosurgical dilemma regarding the appropriate management of acute SDHs in patients receiving continuous treprostinil infusion.
authors: Department of Neurosurgery, Tufts Medical Center, Boston, MA 02110, USA.
authors: Mina
authors: M
authors: Safain
authors: Matthew
authors: M
authors: Shepard
authors: Jason
authors: J
authors: Rahal
authors: James
authors: J
authors: Kryzanski
authors: Steven
authors: S
authors: Hwang
authors: Marie
authors: M
authors: Roguski
authors: Ron I
authors: RI
authors: Riesenburger
mesh_terms: D000368:Aged; D000959:Antihypertensive Agents / Q000008:administration & dosage / Q000627:therapeutic use*; D003399:Craniotomy; D019468:Disease Management; D011464:Epoprostenol / Q000008:administration & dosage / Q000031:analogs & derivatives* / Q000627:therapeutic use; D065627:Familial Primary Pulmonary Hypertension; D005260:Female; D020199:Hematoma, Subdural, Acute / Q000601:surgery*; D006801:Humans; D006976:Hypertension, Pulmonary / Q000188:drug therapy*; D055104:Infusions, Subcutaneous; D016896:Treatment Outcome
chemical_list: D000959:Antihypertensive Agents; D011464:Epoprostenol; C427248:treprostinil