title: Anticoagulation management of myocardial infarction after deep brain stimulation: a comparison of two cases.
abstract: Deep brain stimulation (DBS) is an established treatment of various diseases, particularly used for idiopathic Parkinson's disease. Frequently, DBS patients are multimorbid and managing them may be challenging, since postoperative complications can become more likely with age. In this article, we present two cases of myocardial infarction after DBS with different therapeutic strategies. Case 1 was anticoagulated with a heparin infusion with a target partial thromboplastine time (PTT) between 50 and 60 s after the myocardial infarction and showed 3 days later, after an initial postoperative inconspicuous cranial computer tomography, an intracerebral haematoma, which was evacuated without explanting the DBS lead. Case 2 was only treated with enoxaparine 40 mg s.c. twice a day after the myocardial infarction without any further complications. Both cases benefited from the DBS with respect to the motor fluctuations, but case 1 continued to suffer from psychomotor slowdown, mild hemiparesis of the left side, visual neglect and a gaze paresis. Unfortunately, there are no established guidelines or therapy recommendations for the management of such patients. An individual therapy regime is necessary for this patient population regarding the bleeding risk, the cardial risk and the symptoms of the patient. Retrospectively, the rejection of the intravenous application of heparin in case 2 seems to be the right decision. But regarding the small number of cases, it remains still an individual therapy. Further experience will help us to develop optimal therapy strategies for this patient population.
authors.affiliation: Departement of Neurosurgery, Carl Gustav Carus Medical School, Technical University of Dresden, Fetscherstr. 74, 01307, Dresden, Germany. witold.polanski@uniklinikum-dresden.de
authors.forename: Witold
authors.initials: W
authors.lastname: Polanski
authors.forename: Jan
authors.initials: J
authors.lastname: Koy
authors.forename: Tareq
authors.initials: T
authors.lastname: Juratli
authors.forename: Martin
authors.initials: M
authors.lastname: Wolz
authors.forename: Lisa
authors.initials: L
authors.lastname: Klingelhöfer
authors.forename: Mareike
authors.initials: M
authors.lastname: Fauser
authors.forename: Alexander
authors.initials: A
authors.lastname: Storch
authors.forename: Gabriele
authors.initials: G
authors.lastname: Schackert
authors.forename: Stephan B
authors.initials: SB
authors.lastname: Sobottka
mesh_terms: D000925:Anticoagulants / Q000627:therapeutic use*; D046690:Deep Brain Stimulation / Q000379:methods; D005260:Female; D006493:Heparin / Q000627:therapeutic use*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000188:drug therapy*; D010300:Parkinson Disease / Q000503:physiopathology / Q000628:therapy*; D012189:Retrospective Studies; D020531:Subthalamic Nucleus / Q000503:physiopathology*; D016896:Treatment Outcome
chemical_list: D000925:Anticoagulants; D006493:Heparin