A Case of COVID‑19 with Recent Surgery for Subdural Hematoma – A Therapeutic Thromboprophylaxis Dilemma

Editorial

Authors

Department of Anaesthesiology and Critical Care, Armed Forces Medical College, Pune, Maharashtra, India

Abstract

Dear Sir,
The practice of preemptively administering therapeutic doses of 
low‑molecular‑weight heparin (LMWH) to prevent the dreaded 
complication of venous thromboembolism in COVID‑19 cases 
is practiced globally.[1,2] LMWH increases the chances of 
bleeding, but since COVID‑19 causes a relative prothrombotic 
state, it is needed to administer LMWH in such cases. Chronic 
subdural hematoma (cSDH) is one of the most common 
surgical interventions in daily neurosurgical procedures 
in which mortality and morbidity vary with urgency and 
postoperative complications. The risk of recurrent hematoma 
after cSDH is 5%–30% within a span of 2–3 months.[3] An 
anticoagulant drug like LMWH is a known risk factor for 
cSDH. The use of anticoagulants in severe COVID‑19 patients 
in postoperative cSDH is controversial. Here, we present a 
clinical dilemma to initiate LMWH in a patient suffering from 
severe COVID‑19 infection in postoperative cSDH surgery.

References

1. Costanzo L, Palumbo FP, Ardita G, Antignani PL, Arosio E, Failla G,et al. Coagulopathy, thromboembolic complications, and the use of heparin in COVID‑19 pneumonia. J Vasc Surg Venous Lymphat Disord 2020;8:711‑6.
2. Marwah V, Peter DK, Malik V, Mishra SC, Kumar TA, Kumar A, et al.Pulmonary embolism in coronavirus disease 2019: The silent killer. Med J Armed Forces India 2021;77:S312‑8.
3. Oh HJ, Lee KS, Shim JJ, Yoon SM, Yun IG, Bae HG. Postoperative course and recurrence of chronic subdural hematoma. J Korean Neurosurg Soc 2010;48:518‑23.
4. Harikrishnan P, Mohakuda S, Pathak B, Singh AR, Tilak T, Srinath R,et al. Atypical presentations in COVID‑19‑lung abscess, pulmonary thromboembolism and ST‑elevation myocardial infarction: Diagnosis and management in a temporary COVID‑19 hospital. J Mar Med Soc 2020;22:S128‑32.
5. Yadav YR, Parihar V, Namdev H, Bajaj J. Chronic subdural hematoma. Asian J Neurosurg 2016;11:330‑42.
Archives of Trauma Research
Volume 10, Issue 4 - Serial Number 4
October 2021
Pages 235-236

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History

  • Receive Date: 07 September 2022
  • Accept Date: 07 September 2022

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